"One medic finds that moves towards political reform have not benefited his patients in Burma's remote border areas.
"Nyunt Win is a surgeon and medical trainer working with a mobile clinic in the East Burma jungle. He is also a former soldier of the Karen National Liberation Army.
Nyunt Win's patients are the displaced Karen people who as well as suffering the effects of years of civil war are without any healthcare whatsoever.
With moves towards political reform and international aid going directly to the government under the guise of development projects, there is an increase in resource exploitation, human rights abuses and displacement of ethnic populations. The plight of Nyunt Win's patients seems to be more acute than ever...The Jungle Surgeon of Myanmar exposes what life is like in the remote areas of Myanmar. It shows this marginalised community's fight for survival and thoughts on longterm peace, providing an alternative perspective on the ceasefire."

Findings:
"Out of all 665 households surveyed, 30% reported a human rights violation. Forced labor was
the most common human rights violation reported; 25% of households reported experiencing
some form of forced labor in the past year, including being porters for the military, growing
crops, and sweeping for landmines. Physical attacks were less common; about 1.3% of households
reported kidnapping, torture, or sexual assault.
Human rights violations were significantly worse in the area surveyed in Tavoy, Tenasserim
Division, which is completely controlled by the Burmese government and is also the site of the
Dawei port and economic development project. Our research shows that more people who lived
in Tavoy experienced human rights violations than people who lived elsewhere in our sampling
area. Specifically, the odds of having a family member forced to be a porter were 4.4 times
higher than for families living elsewhere. The same odds for having to do other forms of forced
labor, including building roads and bridges, were 7.9 times higher; for being blocked from accessing
land, 6.2 times higher; and for restricted movement, 7.4 times higher for families in
Tavoy than for families living elsewhere. The research indicates a correlation between development
projects and human rights violations, especially those relating to land and displacement.
PHR’s research indicated that 17.4% of households in Karen State reported moderate or severe
household hunger, according to the FANTA-2 Household Hunger Scale, a measure of food insecurity.
We found that 3.7% of children under 5 were moderately or severely malnourished, and
9.8% were mildly malnourished, as determined by measurements of middle-upper arm circumference.
PHR conducted the survey immediately following the rice harvest in Karen State, and
the results may therefore reflect the lowest malnutrition rates of the year.....Conclusion:
PHR’s survey of human rights violations and humanitarian indicators in Karen State shows that
human rights violations persist in Karen State, despite recent reforms on the part of President
Thein Sein. Of particular concern is the prevalence of human rights violations even in areas
where there is no active armed conflict, as well as the correlation between economic development
projects and human rights violations. Our research found that human rights violations
were up to 10 times higher around an economic development project than in other areas surveyed.
Systemic reforms that establish accountability for perpetrators of human rights violations,
full political participation by Karen people and other ethnic minorities, and access to essential
services are necessary to support a successful transition to a fully functioning democracy..."

"This report contains the full transcript of an interview conducted during April 2011 in Pa’an Township, Thaton District by a villager trained by KHRG to monitor human rights conditions. The villager interviewed Daw Ny---, who described an incident which occurred in November 2010, during which Tatmadaw Border Guard soldiers fired small-arms at her husband without warning and without attempting to hail him, seriously injuring his leg and necessitating 3,800,000 kyat [US $4,935.06] in medical expenses, which has had a deleterious effect on her family’s financial situation. Daw Ny--- told the villager who conducted this interview that her husband was visited in hospital by government officials investigating the incident but that no compensation or redress was offered. Daw Ny--- also described arbitrary demands for food and money, and the illegal logging of teak trees from A--- village by Border Guard soldiers; she mentioned that the imbalance in local power dynamics between armed soldiers and unarmed villagers deters villagers from attempting to engage and negotiate with perpetrators. Daw Ny--- raised concerns about the lack of livelihoods opportunities, and corresponding food insecurity, for villagers who do not own farmland; she notes that, in spite of these challenges, villagers offer voluntary material support to schoolteachers and often attempt to support their livelihoods by selling firewood or cutting bamboo. Daw Ny--- notes that some villagers choose to seek employment opportunities in larger towns but strongly expresses her unwillingness to move to an urban area, believing that food insecurity would only be exacerbated by a lack of money and an absence of alternative livelihood opportunities."

"This report presents primary evidence of attacks on education and health in eastern Burma collected by KHRG during the period February 2010 to May 2011. Section I of this report details KHRG research methodology; Section II analyses general trends in armed conflict and details a loose typology of attacks identified during the reporting period. Section III applies this typology to 16 particularly illustrative incidents, and analyses them in light of relevant international humanitarian law and UN Security Council resolutions 1612, 1882 and 1998. These incidents were selected from a database detailing 59 attacks on civilians documented by KHRG between February 2010 and May 2011."

"This paper highlights impediments to effective international responses to attacks on health and education
in eastern Burma presented by lack of clarity regarding the meaning of “attacks” within the monitoring and
reporting framework established by UN Security Council resolutions 1612 and 1998. In order to address
this definitional ambiguity and enable recent developments in the UN Security Council to potentially
provide support to communities facing attacks in eastern Burma, this paper argues for interpreting
“attacks” in a fashion that is consistent with applicable international humanitarian law. The analysis below
concludes that UN-led monitoring, reporting and response pursuant to UNSCRs 1612 and 1998 should
include acts by parties to armed conflict that both: a) violate relevant international law; and b) attack or
threaten to attack personnel related to schools or medical facilities and/ or destroy, damage or force the
closure of a school or medical facility."

Executive Summary: "This report reveals that the health of populations in conflict-affected areas of eastern Burma, particularly women and children, is amongst the worst in the world, a result of official disinvestment in health, protracted conflict and the abuse of civilians..."Diagnosis: Critical" demonstrates that a vast area of
eastern Burma remains in a chronic health
emergency, a continuing legacy of longstanding
official disinvestment in health, coupled with
protracted civil war and the abuse of civilians. This
has left ethnic rural populations in the east with
41.2% of children under five acutely malnourished.
60.0% of deaths in children under the age of 5 are
from preventable and treatable diseases, including
acute respiratory infection, malaria, and diarrhea.
These losses of life would be even greater if it were
not for local community-based health organizations,
which provide the only available preventive and
curative care in these conflict-affected areas.
The report summarizes the results of a large scale
population-based health and human rights survey
which covered 21 townships and 5,754 households
in conflict-affected zones of eastern Burma. The
survey was jointly conducted by the Burma Medical
Association, National Health and Education
Committee, Back Pack Health Worker Team and
ethnic health organizations serving the Karen,
Karenni, Mon, Shan, and Palaung communities.
These areas have been burdened by decades of civil
conflict and attendant human rights abuses against
the indigenous populations.
Eastern Burma demographics are characterized by
high birth rates, high death rates and the significant
absence of men under the age of 45, patterns more
comparable to recent war zones such as Sierra
Leone than to Burma’s national demographics.
Health indicators for these communities, particularly
for women and children, are worse than Burma’s
official national figures, which are already amongst
the worst in the world. Child mortality rates are
nearly twice as high in eastern Burma and the
maternal mortality ratio is triple the official national
figure.
While violence is endemic in these conflict zones,
direct losses of life from violence account for only
2.3% of deaths. The indirect health impacts of the
conflict are much graver, with preventable losses
of life accounting for 59.1% of all deaths and malaria
alone accounting for 24.7%. At the time of the
survey, one in 14 women was infected with Pf
malaria, amongst the highest rates of infection in
the world. This reality casts serious doubts over
official claims of progress towards reaching the
country’s Millennium Development Goals related to the health of women, children, and infectious
diseases, particularly malaria.
The survey findings also reveal widespread human
rights abuses against ethnic civilians. Among
surveyed households, 30.6% had experienced
human rights violations in the prior year, including
forced labor, forced displacement, and the
destruction and seizure of food. The frequency and
pattern with which these abuses occur against
indigenous peoples provide further evidence of the
need for a Commission of Inquiry into Crimes
against Humanity. The upcoming election will do
little to alleviate the situation, as the military forces
responsible for these abuses will continue to
operate outside civilian control according to the
new constitution.
The findings also indicate that these abuses are
linked to adverse population-level health outcomes,
particularly for the most vulnerable members of
the community—mothers and children. Survey
results reveal that members of households who
suffer from human rights violations have worse
health outcomes, as summarized in the table above.
Children in households that were internally
displaced in the prior year were 3.3 times more
likely to suffer from moderate or severe acute
malnutrition. The odds of dying before age one was
increased 2.5 times among infants from households
in which at least one person was forced to provide
labor.
The ongoing widespread human rights abuses
committed against ethnic civilians and the blockade
of international humanitarian access to rural
conflict-affected areas of eastern Burma by the
ruling State Peace and Development Council (SPDC),
mean that premature death and disability,
particularly as a result of treatable and preventable
diseases like malaria, diarrhea, and respiratory
infections, will continue.
This will not only further devastate the health of
communities of eastern Burma but also poses a
direct health security threat to Burma’s neighbors,
especially Thailand, where the highest rates of
malaria occur on the Burma border. Multi-drug
resistant malaria, extensively drug-resistant
tuberculosis and other infectious diseases are
growing concerns. The spread of malaria resistant
to artemisinin, the most important anti-malarial
drug, would be a regional and global disaster.
In the absence of state-supported health
infrastructure, local community-based organizations
are working to improve access to health services in
their own communities. These programs currently
have a target population of over 376,000 people in
eastern Burma and in 2009 treated nearly 40,000
cases of malaria and have vastly increased access
to key maternal and child health interventions.
However, they continue to be constrained by a lack
of resources and ongoing human rights abuses by
the Burmese military regime against civilians. In
order to fully address the urgent health needs of
eastern Burma, the underlying abuses fueling the
health crisis need to end."

Language:

Burmese, English, Thai

Source/publisher:

The Burma Medical Association, National Health and Education Committee, Back Pack Health Worker Team

A new report by NGOs indicates health conditions in conflict-affected eastern Myanmar are dire, with women and children suffering most.
According to "Diagnosis: Critical", a survey of 5,754 households by health organizations working in the Thai border town of Mae Sot and others from neighbouring Myanmar, health conditions in eastern Myanmar have deteriorated due to constant conflict and persistent state neglect.

"For the people of Burma, 2008 has been another difficult year. The difficulties related to lack
of healthcare facilities continued, while other factors relating to poverty remained key
influences on the health of the nation. The enduring story from Burma from 2008 was the
humanitarian consequences of Tropical Cyclone Nargis, which hit the country on 2-3 May
2008. However, even at the beginning of the year, there were worrying reports and statistics
emerging from Burma regarding the health status of the population.
In January 2008, the United Nations Children’s Fund (UNICEF) released figures which
showed Burma had the second highest child mortality rate in the world, with between 270
and 400 children dying on a daily basis, many from preventable causes. By year end, the
combination of the estimated 130,000 deaths due to Cyclone Nargis and the increasing
HIV/AIDS crisis lead Médecins Sans Frontières (MSF) to describe the current situation in
Burma as “critical”, and also contributed to Burma being included in MSF’s list of the ten
worse humanitarian situations in the world. While it has been estimated that approximately
half of Burma's annual budgetary allocation goes towards military expenditure, less than half
a percent of Burma’s Gross Domestic Product (GDP) is allocated to healthcare. Burma’s
per capita spending on healthcare has been reported to be "the lowest in the world". As a
direct result, deaths arising from easily preventable and readily treatable diseases are
common. Burma also has the second highest child mortality rate in all of Asia, with ten
percent of children dying before their fifth birthday; only Afghanistan’s child mortality rate is
higher.
While the State Peace and Development Council (SPDC) military regime makes little to no
effort to actively promote good health or to provide adequate healthcare, in some areas it
actively prevents the population’s access to healthcare through restrictions on movement
and other human rights abuses. For example, in August 2008, it was reported that medical
students were to be forced to take an exam on the current political situation in the country
before being allowed to take up medical placements in hospitals. Presumably, those
students who failed to toe the SPDC line would not have been permitted to commence their
placements. Although this was denied by the SPDC, it was confirmed by lecturers at
Rangoon’s Medical Institute..."

"In October 2008, reports
emerged from Burma that the
military junta had ordered its
courts to expedite the trials of
political activists. Since then,
357 activists have been handed
down harsh punishments,
including sentences of up to 104
years. Shortly after sentencing,
the regime began to
systematically transfer political
prisoners to prisons all around
Burma, far from their families. This has a serious detrimental impact on both their
physical and mental health. Medical supplies in prisons are wholly inadequate, and often
only obtained through bribes to prison officials. It is left to the families to provide
medicines, but prison transfers make it very difficult for them to visit their loved ones in
jail. Prison transfers are also another form of psychological torture by the regime, aimed
at both the prisoners and their families. Since November 2008, at least 228 political
prisoners have been transferred to jails away from their families. The long-term
consequences for the health of political prisoners recently transferred will be very serious.
At least 127 political prisoners are currently in poor health. At least 19 of them are in
urgent need of proper medical treatment. Political prisonersÃ¢' right to healthcare is
systematically denied by the regime. Burma's healthcare system in prisons is completely
inadequate, especially in jails in remote areas. There are 44 prisons across Burma, and at
least 50 labour camps. Some of them do not have a prison hospital, and at least 12 of the
prisons do not even have a prison doctor.
The regime's treatment of political prisoners directly contravenes the 1957 UN standard
minimum rules for the treatment of prisoners. The International Committee of the Red
Cross (ICRC) carried out its last prison visit in Burma in November 2005. In January
2006 the ICRC suspended prison visits in the country, as it was not allowed to fulfil its
independent, impartial mandate.
Since 1988 at least 139 political prisoners have died in detention, as a direct result of
severe torture, denial of medical treatment, and inadequate medical care. Many, like Htay
Lwin Oo, were suffering from curable diseases such as tuberculosis. He died in
Mandalay Prison in December 2008. He had been due for release in December this year...
1. Political Prisoners In Poor Health
There are currently at least 127 political prisoners known to be in poor health..."

An independent, community-based assessment of health and human
rights in the Cyclone Nargis response...DISCUSSION AND CONCLUSIONS:
"To date, this report is the only community-based independent assessment of the Nargis response
conducted by relief workers operating free of SPDC control. Using participatory methods and
operating without the knowledge or consent of the Burmese junta or its affiliated institutions, this
report brings forward the voices of those working “on the ground” and of survivors in the Cyclone
Nargis-affected areas of Burma.
The data reveal systematic obstruction of relief aid, willful acts of theft and sale of relief supplies,
forced relocation, and the use of forced labor for reconstruction projects, including forced child
labor. The slow distribution of aid, the push to hold the referendum vote, and the early refusal to
accept foreign assistance are evidence of the junta’s primary concerns for regime survival and
political control over the well-being of the Burmese people.
These EAT findings are evidence of multiple human rights violations and the abrogation of
international humanitarian relief norms and international legal frameworks for disaster relief. They
may constitute crimes against humanity, violating in particular article 7(1)(k) of the Rome Statute
of the International Criminal Court, and a referral for investigation by the International Criminal
Court should be made by the United Nations Security Council".

"...Chronic divestment in health, alongside draconian restrictions, harassment and the incarceration of relief workers, remain the root drivers of the health and humanitarian crises in Burma. These are the real human rights violations that affect health—not sanctions...official restrictions governing the work of international aid agencies have been tightened, particularly the rules covering domestic travel and data collection. Their priorities are clear: until the global community has the moral fortitude to address this underlying reality, the humanitarian crises of Burma will continue, especially for the 70 Burmese HIV patients who will die today from lack of care"

"...The people of Myanmar cannot wait until the next big disaster for their critical health needs to be recognized; both the government of Myanmar and the international community urgently need to act in order prevent thousands of unnecessary deaths..."...contains a 6-minute podcast: "MSF Frontline Reports - Myanmar Cyclone Emergency II
May 2008" and a slide show:
"A Preventable Fate: The Failure of HIV/AIDS Treatment in Myanmar...
Thousands of people are needlessly dying due to a severe lack of lifesaving HIV/AIDS treatment in Myanmar. Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises, MSF insists that the government of Myanmar and international organizations urgently and rapidly scale-up the provision of antiretroviral therapy (ART)."

"IN THE FIELD of disaster relief studies it is a truism that the first responders, whether in an earthquake or a
cyclone, are generally ordinary people in the affected area who have survived. They are the first to start
digging out the rubble or tending the wounded. Civilian volunteers are the backbone of the later phases of
emergency responses too - people who bring food and water, volunteer at shelters, give what they can. Only
in a system as profoundly inhumane as Burma would such good Samaritans be punished for their
compassion. But that is precisely what happened last week..."

Executive Summary: The situation for many people living with HIV in Myanmar is critical due to a severe lack of lifesaving antiretroviral treatment (ART). MSF currently provides ART to more than 11,000 people. That is the majority of all available treatment countrywide but only a small fraction of what is urgently needed. For five years MSF has continually developed its HIV/AIDS programme to respond to the extensive needs, whilst the response of both the Government of Myanmar and the international community has remained minimal. MSF should not bear the main responsibility for one of Asia’s most serious HIV/AIDS epidemics. Pushed to its limit by the lack of other services providing ART, MSF has had to make the painful
decision to restrict the number of new patients it can treat. With few options to refer new patients for treatment elsewhere, the situation is dire.
An estimated 240,000 people are currently infected with HIV in Myanmar. 76,000 of these people are in urgent need of ART, yet less than 20 % of them receive it through the combined efforts of MSF, other international non-governmental organizations (NGOs) and the Government of Myanmar.
For the remaining people the private market offers little assistance as the most commonly used first-line treatment costs the equivalent of a month’s average wage. The lack of accessible treatment resulted in 25,000 AIDS related deaths in 2007 and a similar number of people are expected to suffer the same fate this year, unless HIV/AIDS services - most importantly the provision of ART - are urgently scaled-up.
The Government of Myanmar and the International Community need to mobilize quickly in order to address this situation. Currently,
the Government spends a mere 0.3% of the gross domestic product on health, the lowest amount worldwide4, a small portion of which goes to HIV/AIDS. Likewise, overseas development aid for Myanmar is the second lowest per capita worldwide and few of the big international donors provide any resources to the country. Yet, 189 member states of the United Nations, including
Myanmar, endorsed the Millennium Development Goals, including the aim to “Achieve universal access to treatment for HIV/AIDS for all those who need it, by 2010”. As it stands, this remains a far cry from becoming a reality in Myanmar. As an MSF ART patient in Myanmar stated, “All people must have a spirit of humanity in helping HIV patients regardless of nation, organization or government. We are all human beings so we must help each other”. Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises,
MSF insists that the Government of Myanmar and international organizations
urgently and rapidly scale-up ART provision. A vast gulf exists between the needs related to HIV/AIDS and the services provided. Unless ART provision is rapidly scaled-up many more people will needlessly suffer and die.

"With largely consolidated control over Dooplaya District in southern Karen State the SPDC and DKBA, as the two dominant (and allied) military forces, operate under a system of coexistence. The local civilian population, in turn, faces exploitative governance on two fronts as both SPDC and DKBA soldiers seek to extract money, labour, food and other supplies from them. Enforcing heavy movement restrictions on top of persistent exploitative demands, local communities are facing deteriorating livelihood opportunities, increasing poverty, and a constriction of educational and health care opportunities. Persistent human rights abuses thus foster the economic pressures fuelling the continuing migration of rural communities in Dooplaya District to refugee camps in Thailand and towards livelihood opportunities at urban centres in Burma and Thailand. This report examines the situation of abuse in Dooplaya District from January to June 2008..."

Conclusion:
"Continued conflict and consistent human rights violations have increased
mortality rates and worsened the health status of IDPs and other vulnerable
populations in Burma. Collaboration with and partnerships among border-based
health organisations have proved to be viable solutions towards providing
primary health care to these vulnerable populations, and should be a focus for
the international public health community. Without an end to human rights
violations in Burma, however, any improvements in health status are unlikely
to be sustained".

Author/creator:

Mahn Mahn, Katherine C. Teela, Catherine I. Lee and Cara O’Connor

Language:

English

Source/publisher:

2007 Myanmar/Burma Update Conference via Australian National University

This link leads to a document containing the Table of Contents of the report, with links to the English, Burmese and Thai versions...
Executive Summary: "Disinvestment in health, coupled with widespread poverty, corruption, and the dearth of skilled personnel have resulted in the collapse of Burma’s health system. Today, Burma’s health indicators by official figures are among the worst in the region. However, information collected by the Back Pack Health Workers Team (BPHWT) on the eastern frontiers of the country, facing decades of civil war and widespread human rights abuses, indicate a far greater public health catastrophe in areas where official figures are not collected.
In these eastern areas of Burma, standard public health indicators such as population pyramids, infant mortality rates, child mortality rates, and maternal mortality ratios more closely resemble other countries facing widespread humanitarian disasters, such as Sierra Leone, the Democratic Republic of the Congo, Niger, Angola, and Cambodia shortly after the ouster of the Khmer Rouge. The most common cause of death continues to be malaria, with over 12% of the population at any given time infected with Plasmodium falciparum, the most dangerous form of malaria. One out of every twelve women in this area may lose her life around the time of childbirth, deaths that are largely preventable. Malnutrition is unacceptably common, with over 15% of children at any time with evidence of at least mild malnutrition, rates far higher than their counterparts who have fled to refugee camps in Thailand. Knowledge of sanitation and safe drinking water use remains low.
Human rights violations are very common in this population. Within the year prior, almost a third of households had suffered from forced labor, almost 10% forced displacement, and a quarter had had their food confiscated or destroyed. Approximately one out of every fifty households had suffered violence at the hands of soldiers, and one out of 140 households had a member injured by a landmine within the prior year alone. There also appear to be some regional variations in the patterns of human rights abuses. Internally displaced persons (IDPs) living in areas most solidly controlled by the SPDC and its allies, such as Karenni State and Pa’an District, faced more forced labor while those living in more contested areas, such as Nyaunglebin and Toungoo Districts, faced more forced relocation. Most other areas fall in between these two extremes. However, such patterns should be interpreted with caution, given that the BPHW survey was not designed to or powered to reliably detect these differences.
Using epidemiologic tools, several human rights abuses were found to be closely tied to adverse health outcomes. Families forced to flee within the preceding twelve months were 2.4 times more likely to have a child (under age 5) die than those who had not been forcibly displaced. Households forced to flee also were 3.1 times as likely to have malnourished children compared to those in more stable situations.
Food destruction and theft were also very closely tied to several adverse health consequences. Families which had suffered this abuse in the preceding twelve months were almost 50% more likely to suffer a death in the household. These households also were 4.6 times as likely to have a member suffer from a landmine injury, and 1.7 times as likely to have an adult member suffer from malaria, both likely tied to the need to forage in the jungle. Children of these households were 4.4 times as likely to suffer from malnutrition compared to households whose food supply had not been compromised.
For the most common abuse, forced labor, families that had suffered from this within the past year were 60% more likely to have a member suffer from diarrhea (within the two weeks prior to the survey), and more than twice as likely to have a member suffer from night blindness (a measure of vitamin A deficiency and thus malnutrition) compared to families free from this abuse.
Not only are many abuses linked statistically from field observations to adverse health consequences, they are yet another obstacle to accessing health care services already out of reach for the majority of IDP populations in the eastern conflict zones of Burma. This is especially clear with women’s reproductive health: forced displacement within the past year was associated with a 6.1 fold lower use of contraception. Given the high fertility rate of this population and the high prevalence of conditions such as malaria and malnutrition, the lack of access often is fatal, as reflected by the high maternal mortality ratio—as many as one in 12 women will die from pregnancy-related complications.
This report is the first to measure basic public health indicators and quantify the extent of human rights abuses at the population level amongst IDP communities living in the eastern conflict zones of Burma. These results indicate that the poor health status of these IDP communities is intricately and inexorably linked to the human rights context in which health outcomes are observed. Without addressing factors which drive ill health and excess morbidity and mortality in these populations, such as widespread human rights abuses and inability to access healthcare services, a long-term, sustainable improvement in the public health of these areas cannot occur..."

Conclusion:
"The displacement in Thilawa took place amid a broader
climate of state-sponsored abuse in Burma, where
people have no recourse to challenge illegal government
action. Specifically, the displacement process in Thilawa
violated residents’ human rights, negatively affected
their ability to provide for themselves, and resulted in
deteriorating food security and limited ability to access
health care. The TSEZMC will relocate 846 more
households when development begins on phase two of
the project. If the TSEZMC, the Burmese government,
and JICA continue to operate as they did in the first
phase of the project, these households will suffer the
same fate.
Burma requires economic development, but given the
historical context of forced displacement, impunity for
human rights violations, weak rule of law, and
corruption, there is great risk that economic
development projects will benefit a select few in power
at the expense of deepened deprivation and poverty for
many others. Although the results of this survey cannot
be generalized for the country as a whole, the survey
does highlight risks inherent to any major development
project in Burma. Having recently emerged from more
than 50 years of military dictatorship, it will take time
and commitment to build a strong civil society that is
capable of educating people in Burma about their rights.
Residents generally fear their government, which for
decades has controlled the population by force. The
government has yet to implement sufficient
mechanisms to protect people from human rights
abuses and ensure justice for victims.
Given this context, any development project in the
country carries great risk of human rights violations.
JICA and other organizations implementing such
projects should make every effort to proactively identify
the potential negative outcomes and consult with the
affected community about how best to minimize or
eliminate these risks. The Thilawa case suggests that
foreign organizations cannot rely on the Burmese
government to protect the human rights of forcibly displaced
populations..."

"As the effects of climate change are increasingly experienced around the world, the impacts of on health become clearer and deeper. In 2009, The Lancet stated climate change as “the biggest global health threat of the 21st century”. Both physical and mental health, as well as health systems, are affected, including from extreme weather events such as flooding, weakened infrastructure, depleted agricultural production, pollution, forced migration and destroyed livelihoods..."

In 2004 the Global Fund to Fight AIDS, Tuberculosis, and Malaria (“Global Fund”) awarded program grants to Burma (Myanmar) totaling US$98.4 million over five years—recognizing the severity of Burma’s HIV/AIDS and tuberculosis (TB) epidemics, and noting that malaria was the leading cause of morbidity and mortality, and the leading killer of children under five years old [1]. For those individuals working in health in Burma, these grants were welcome, indeed [2].

The purpose of the study was to ascertain the therapeutic efficacy of different treatments for uncomplicated falciparum
malaria in the hospitals in Sagaing, northern and eastern Shan, to facilitate updating the existing national antimalarial
drug policy. The proposed 14-day trial for monitoring the efficacy of treatments of uncomplicated falciparum malaria is
an efficient method for identifying treatment failure patterns at the intermediate level (township hospital) in the Union
of Myanmar. Minimal clinical and parasitological data for days 0±14 were required to classify treatment failure and
success. Clinical and parasitological responses on day 3 and days 4±14 were used as clear examples of early and late
treatment failure, respectively. Mefloquine is five times more likely to be effective than chloroquine and sulfadoxine-
pyrimethamine (S-P), whereas chloroquine and S-P treatments have nearly identical failure patterns. The alarming
frequency of clinical and parasitological failure (failure rate >50%) following chloroquine treatment was reported in
Sagaing and following S-P treatment in Sagaing and eastern Shan.

Major infectious diseases: degree of risk: very high ...
food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever ...
vectorborne diseases: dengue fever and malaria ...
water contact disease: leptospirosis ...
animal contact disease: rabies ...
note: highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds (2009) ...
Definition: This entry lists major infectious diseases likely to be encountered in countries where the risk of such diseases is assessed to be very high as compared to the United States. These infectious diseases represent risks to US government personnel traveling to the specified country for a period of less than three years. The degree of risk is assessed by considering the foreign nature of these infectious diseases, their severity, and the probability of being affected by the diseases present. The diseases listed do not necessarily represent the total disease burden experienced by the local population.

Conclusion: "Boatmen in Teknaf are an integral part of a high-risk sexual behaviour
network between Myanmar and Bangladesh. They are at risk of obtaining HIV infection
due to cross border mobility and unsafe sexual practices. There is an urgent need for
designing interventions targeting boatmen in Teknaf to combat an impending epidemic of
HIV among this group. They could be included in the serological surveillance as a
vulnerable group. Interventions need to address issues on both sides of the border, other
vulnerable groups, and refugees. Strong political will and cross border collaboration is
mandatory for such interventions."

Abstract:
"Decades of neglect and abuses by the Burmese government have decimated the health of the
peoples of Burma, particularly along her eastern frontiers, overwhelmingly populated by
ethnic minorities such as the Shan. Vast areas of traditional Shan homelands have been
systematically depopulated by the Burmese military regime as part of its counter-insurgency
policy, which also employs widespread abuses of civilians by Burmese soldiers, including
rape, torture, and extrajudicial executions. These abuses, coupled with Burmese government
economic mismanagement which has further entrenched already pervasive poverty in rural
Burma, have spawned a humanitarian catastrophe, forcing hundreds of thousands of ethnic
Shan villagers to flee their homes for Thailand. In Thailand, they are denied refugee status
and its legal protections, living at constant risk for arrest and deportation. Classified as
“economic migrants,” many are forced to work in exploitative conditions, including in the
Thai sex industry, and Shan migrants often lack access to basic health services in Thailand.
Available health data on Shan migrants in Thailand already indicates that this population
bears a disproportionately high burden of infectious diseases, particularly HIV, tuberculosis,
lymphatic filariasis, and some vaccine-preventable illnesses, undermining progress made by
Thailand’s public health system in controlling such entities. The ongoing failure to address
the root political causes of migration and poor health in eastern Burma, coupled with the
many barriers to accessing health programs in Thailand by undocumented migrants,
particularly the Shan, virtually guarantees Thailand’s inability to sustainably control many
infectious disease entities, especially along her borders with Burma."

Overview of the January 2007 conference, “Responding to Infectious
Diseases in the Border Regions of South and Southeast Asia” hosted by the Faculty of Tropical Medicine of Mahidol University in
Bangkok, Thailand.

How Burma’s dams project could spread disease...
"When Nang A Cha, a Shan migrant, consulted a doctor in Chiang Mai, northern Thailand, complaining of a fever and a swollen leg, the physician initially suspected malaria. A blood test ruled that out, but the young laboratory technician was still puzzled by what he saw under the microscope and sent the blood smear to his supervisor, a semi-retired man who had been trained in parasitology about 40 years previously.
He was astounded by what he saw: for the first time in 30 years, he gazed at an old nemesis, an entity believed eradicated from urban Thailand. There was no mistaking the threadlike shadows in the blood smear: Wuchereria bancrofti, the parasite responsible for lymphatic filariasis, more colloquially known as elephantiasis, a term conjuring up images of grotesquely swollen limbs and severe disability.
Lymphatic filariasis is transmitted by the bite of an infected mosquito. Once inside the human host, the parasite resides in the lymphatic system, producing larvae which then migrate back to the blood and are subsequently picked up by mosquitoes to continue the infection cycle. Over time, progressive damage to the lymphatics causes obstructions and subsequent swelling from accumulation of lymph..."

The Meeting on Development of Health Collaboration along Thailand-Myanmar Border areas:
Five Presentations on Situation on Migrants and Six Report on Selected Health Problems/Activities along the border

Abstract
In June 2001, we assessed mental health problems among Karenni refugees residing in camps in Mae Hong Son,
Thailand, to determine the prevalence of mental illness, identify risk factors, and develop a culturally appropriate
intervention program. A systematic random sample was used with stratification for the three camps; 495 people aged 15
years or older from 317 households participated. We constructed a questionnaire that included demographic
characteristics, culture-specific symptoms of mental illness, the Hopkins Symptoms Checklist-25, the Harvard Trauma
Questionnaire, and selected questions from the SF-36 Health Survey. Mental health outcome scores indicated elevated
levels of depression and anxiety symptoms; post-traumatic stress disorder (PTSD) scores were comparable to scores in
other communities affected by war and persecution. Psychosocial risk factors for poorer mental health and social
functioning outcomes were insufficient food, higher number of trauma events, previous mental illness, and landmine
injuries. Modifications in refugee policy may improve social functioning, and innovative mental health and psychosocial
programs need to be implemented, monitored, and evaluated for efficacy.
Published by Elsevier Ltd.

This study assesses the use of health services among cross-border migrants from Myanmar who are now living in Kanchanaburi Province, western Thailand. The migrants comprise three main ethnic groups, namely the Burmese, Karen and Mon, most of whom have no formal education and are agricultural workers. Results indicate that although the migrants can access government health facilities, they are still more likely to buy drugs or use herbal medicines for treating themselves when they have minor illnesses, while the Thais are more likely to seek medical care from government facilities. The main difficulties for migrants in accessing health services are their legal status, financial constraints, and an inability to speak Thai. Moreover, health beliefs also determine the health-seeking behaviors of migrants, particularly among the Karen who believe in spirits and herbal medicine, while very few of the Burmese and the Mon do so. This leads to the conclusion that ethnicity is an important determinant of the utilization of health services by migrants from Myanmar in Kanchanaburi.

In vitro drug susceptibility profiles were assessed in 75 Plasmodium falciparum isolates from 4 sites in Myanmar. Except at Mawlamyine, the site closest to the Thai border, prevalence and degree of resistance to mefloquine were lower among the Myanmar isolates as compared with those from Thailand. Geometric mean concentration that inhibits 50% (IC50) and 90% (IC90) of Mawlamyine isolates were 51 nM (95% confidence interval [CI], 40-65) and 124 nM (95% CI, 104-149), respectively. At the nearest Thai site, Maesod, known for high-level multidrug resistance, the corresponding values for mefloquine IC50 and IC90 were 92 nM (95% CI, 71-121) and 172 nM (95% CI, 140-211). Mefloquine susceptibility of P. falciparum in Myanmar, except for Mawlamyine, was consistent with clinical-parasitological efficacy in semi-immune people. High sensitivity to artemisinin compounds was observed in this geographical region. The data suggest that highly mefloquine-resistant P. falciparum is concentrated in a part of the Thai-Myanmar border region.

Abstract. This study was conducted to evaluate the efficacy of Saccharomyces boulardii in acute diarrhea. One
hundred hospitalized children in Myanmar (age range 3 months to 10 years) were included. Fifty were treated with
S. boulardii for five days in addition to oral rehydration solution (ORS) and 50 were given ORS alone (control group)
in an alternating order. The mean duration of diarrhea was 3.08 days in the S. boulardii group and 4.68 days (P < 0.05)
in the control group. Stools had a normal consistency on day 3 in 38 (76%) of 50 patients in the S. boulardii group
compared with only 12 (24%) of 50 in the control group (P0.019). On day 2, 27 (54%) of 50 had less than three stools
per day in the S. boulardii group compared with only 15 (30%) of 50 in the control group (P 0.019). Saccharomyces
boulardii shortens the duration of diarrhea and normalizes stool consistency and frequency. The shortening of the
duration of diarrhea results in a social and economic benefits.

GENERAL HEALTH:
Natural history of diarrhea;
General measures for controlling acute diarrhoea and epidemics;
Important facts of diarrhoea in children;
DIAGNOSIS:
Clinical aspects of common diarrhoeal diseases and laboratory confirmation...
MANAGEMENT:
Practical guidelines of diarrhoeal diseases;
Oral rehydration salt: How to prepare correctly and make it at home?...
FROM THE FIELD:
Maela camp experiences of cholera outbreak...
PREVENTION:
Role of environmental sanitation and key measures in prevention and control of diarrhea;
Common methods and technologies used to treat water at a household level;
A closer look at chlorination;
How to deliver effective health education for acute diarrhea...
INTERVIEWS...
Glossary and annual quiz.

Lots of useful material on HIV/AIDS in Burma/Myanmar and the region, but you need to register (free)...On the AHRN site, search for "Myanmar" in "library" (45 results, mainly substantial reports and articles) or "site" (610 results)

"HIV Information for Myanmar [him] is published in memory of Hla Htut Lwin - activist, coworker, and friend. There is a free email list service for anyone with email access and an interest in the response to HIV in Myanmar. Send an email to himhimhim at csloxinfo dot com if you want to become a new subscriber. You will receive one to three postings a day."

"...Some 215,000 people were living with HIV/AIDS in Myanmar in 2011, of whom around 120,000 need lifesaving antiretroviral treatment (ART), which can also prevent the spread of HIV, according to the U.N. agency UNAIDS. But only 40,000 are receiving ART.
The World Health Organization (WHO) says anyone with a CD4 count lower than 350 should get ART. Yet a severe lack of resources means MSF only treats those with a CD4 count below 150 in Myanmar.
The aid group has close to 20 clinics around the country, and provides the lion’s share of ART in the southeast Asian nation.
Nafis Sadik, the U.N. special envoy on HIV/AIDS for Asia Pacific, underlined the fact that only a third of people who need ART in Myanmar are getting it at a time when there is a new global push to treat all HIV-positive patients regardless of their CD4 count.
“The evidence is that the earlier you start, the more protected they are, the less infectious they are,” Dr Sadik told AlertNet during her recent visit to Myanmar. “And like other diseases, if you give treatment early, the survival rates are much higher.”
“There are still 18,000 people who die every year of AIDS-related diseases in Myanmar,” she added..."

OVERVIEW OF STRATEGIC DIRECTIONS:
Table 1: Priority setting of the National Strategic Plan on AIDS – Myanmar 2006‐2010 -
Priority Strategic Directions - Highest priority:
1. Reducing HIV‐related risk, vulnerability and impact
among sex workers and their clients;
2. Reducing HIV‐related risk, vulnerability and impact
among men who have sex with men;
3. Reducing HIV‐related risk, vulnerability and impact
among drug users;
4. Reducing HIV‐related risk, vulnerability and impact
among partners and families of people living with HIV... High priority:
5. Reducing HIV‐related risk, vulnerability and impact
among institutionalized populations;
6. Reducing HIV‐related risk, vulnerability and impact
among mobile populations;
7. Reducing HIV‐related risk, vulnerability and impact
among uniformed services personnel;
8. Reducing HIV‐related risk, vulnerability and impact
among young people...Priority:
9. Enhancing prevention, care, treatment and support in the
workplace...
10. Enhancing HIV prevention among men and women of
reproductive age...Fundamental
overarching issues:
11. Meeting the needs of people living with HIV for
comprehensive care, support and treatment
12. Enhancing the capacity of health systems, coordination
and capacity of local NGOs & community based
organizations
13. Monitoring and Evaluating

"... * Modelling of HIV data show that HIV prevalence in Myanmar peaked in 2001-2002 and has
been slowly declining since then. The HIV incidence peaked a few years earlier and is also
showing a slow decline.
* Like in other Asian countries, there are three distinct waves of the epidemic. The first group to
be affected was the injecting drug users. Next, the sex workers and their male clients were
most affected. Finally, transmission from male clients to their wives/other female partners
resulted in lower-risk female population being increasingly infected. Although a large number
of low-risk female have become infected, IDUs, MSM and sex workers continue to have the
highest incidence rate of HIV infection.
* In 2009, an estimated 238,000 people are living with HIV/AIDS. The adult HIV prevalence is
0.61%.
* Currently, there are approximately 17,000 new HIV infections each year. Nearly 60% of all
new infections are among sex workers and their clients, MSMs and IDUs.
* The number of AIDS deaths is showing a downward trend since 2005. Currently, there are
approximately 17,500 AIDS deaths per year.
* Roughly 74,000 (including old and new persons needing treatment) people in Myanmar are
currently in need of antiretroviral care and this number will continue to increase over the next
years as more people are put under ART.
* Roughly 4,300 HIV-positive women will give birth annually. As PMCT programme expand,
fewer number of children will be born with HIV. Approximately 1,900 children are in need of
ART in 2009..."

"...In the 1990s, Min Thura regularly shared needles with other drug users in Mandalay.
"About 50 drug users were queuing up and giving their arms to inject heroin with only one needle. Many of my friends with whom I shared needles to inject drugs have already died," said Min Thura, who has been clean for four years.
Now, he said, there is more awareness about HIV and clean needles..."

Abstract (provisional):
Background:
The severity of HIV/AIDS pandemic linked to injecting drug use is one of the most worrying medical and social problems throughout the world in recent years. Myanmar has one of the highest prevalence rates of HIV among the IDUs in the region. Aim The objective of the study was to determine the risk behaviours among HIV positive injecting drug users in Myanmar...
Methods:
A non matched case control study was conducted among 217 respondents registered with a non governmental organization's harm reduction center. 78 HIV positive IDUs were used as cases and 139 non HIV positive IDUs as controls. The study was conducted between April-May 2009. Data was analysed using SPSS version 15 and the study was ethically conducted...
Results:
Factors like age, marital status, age first used drugs, drug use expenditure, reason for drug use, age first used injection were found to be significant. Other risk factors found significantly associated with HIV among IDU were education (OR 2.3), location of respondent (OR 2.4) type of syringe first used (OR 5.1), sharing syringe at the first injection (OR 4.5) and failure of drug detoxification programme (OR 4.9). More HIV positive IDUs were returning used syringes in the centre (OR 3.3)...
Conclusions:
Prudent measures such as access to sterile syringes and continuous health education programmes among IDUs and their sexual partners are required to reduce high risk behaviours of IDUs in Myanmar.

"...The Union of Myanmar UNGASS 2010 Report has been posted on HIV Information for Myanmar http://him.civiblog.org/blog/_archives/2010/4/6/4498792.html and was posted in [him] 1166. The [him] moderator has not heard that a shadow report will be produced. Who would risk writing one?
In the absence of a shadow report the [him] moderator would like to offer these observations on the only official report on HIV that will come from the Government of Myanmar this year. The following comments are not meant to be a criticism of those who did all the hard work in producing the report. But publication of the report offers an opportunity for us all to get closer to truth..."

"The HIV epidemic in Myanmar is concentrated, with HIV transmission primarily occurring
in high risk sexual contacts between sex workers and their clients, men who have sex
with men and the sexual partners of these sub-populations. In addition, there is a high
level of HIV transmission among injecting drug users through use of contaminated
injecting equipment, with transmission to sexual partners. Latest modelling estimated the
HIV prevalence in the adult population (aged 15-49) at 0.61% in 2009. For key
populations most-at-risk, surveillance data from 2008 showed HIV prevalence in the
sentinel groups at 18.1% in female sex workers, 28.8% in men who have sex with men,
and 36.3% in male injecting drug users.
It is estimated that around 238,000 people are living with HIV in Myanmar in 2009, of
whom 74,000 are in need of antiretroviral therapy. In the same year, an estimated
17,000 people died of AIDS-related illness. Incidence is estimated at well above 10,000
new infections per year, confirming the continuing need for effective prevention efforts,
with increased emphasis on reaching long term female sexual partners of male most at
risk populations..."

RANGOON, Feb 25, 2010 (IPS) - When Aye Aye (not her real name) leaves her youngest son at home each night, she tells him that she has to work selling snacks. But what Aye actually sells is sex so that her 12-year-old son, a Grade 7 student, can finish his education.

Myanmar is one of the few countries in East Asia that has reported a decrease in the overall
prevalence of HIV in recent years. Estimates indicate that HIV prevalence peaked at about 0.9%
(15-49%). By 2007, the estimated prevalence was 0.7% (range: 0.4-1.1%).....
Myanmar remains the second largest opium
poppy growing country after Afghanistan,
contributing 20% of opium poppy cultivation
in major cultivating countries in 2008.3 Heroin
use has become widespread and is the
primary drug of choice among people who
inject drugs. While the use of heroin and
opium has been observed to be declining in
recent years, the use of methamphetamine
has been increasing since 2003. Injecting of
amphetamine type stimulants has also been
reported to occur, as well as injecting of a
mixture of opiates and pharmaceutical
drugs.

In a country where the government provides minimal general health care, citizens must take up the fight against HIV infection themselves...
"A relatively prosperous transport hub for family-run trucking businesses, Kyaukpadaung’s high incidence of Human Immunodeficiency Virus (HIV/AIDS) among its population is a major downside to the township’s heavy dependence on the transportation industry.
HIV/AIDS activist Phyu Phyu Thin with patients and volunteers at the National League for Democracy offce in Rangoon on World AIDS Day. (Photo: AFP)
With the 1,500-meter peak of Mt Popa nearby bringing cooler breezes and water to an otherwise arid region of eastern Mandalay Division, Kyaukpadang’s location at a major crossroads near the geographical center of Burma favored the town’s development as a trucking center. With larger businesses operating up to 100 trucks, many of the town’s residents are employed in the industry, spending weeks at a time on the road.
On Burma’s roads at night, teenage students are known to flag down trucks with flashlights, hitching rides and lifting skirts, passing from truck to truck, leaving sordid memories and sexually transmitted diseases.
Even if the drivers are aware of the problem and want to protect themselves, condoms are often unavailable in rural stores dimly lit by oil-lamps, where snacks, tobacco and liquor are sold along with the services of garishly made-up teenagers in a tin hut out back. As a result, when men return to their families in Kyaukpadaung, they often take HIV/AIDS with them..."

Kaci Hickox, a nurse from Texas, worked as the primary health care manager for Doctors Without Borders/Médecins Sans Frontières (MSF) programs in northern Rakhine state, Myanmar, from May 2007 to March 2009. The majority of MSF patients in this area, on the border of Bangladesh, are part of an ethnic and Muslim group called the Rohingya. They have great difficulty receiving any health care, as travel restrictions or fees for travel permission keep them confined to their own villages. Even if they can reach health care facilities, often members of this group cannot afford to pay and are subjected to discrimination at government- run hospitals or health centers. During the two years she worked in northern Rakhine state, Hickox’s primary responsibility was managing three rural clinics that serve approximately 110,000 Rohingya people.

"The Costed Operational Plan for the National Strategic Plan is now available. It is a vital reference document" (HIM)..."The National Strategic Plan on HIV and AIDS 2006-2010 provides the strategic framework of action
including priority setting for resource allocation. The associated operational plan specifies the agreed targets
and the costs for each of the 13 strategic directions of the National Strategic Plan. The plan intends to guide
the implementation of all HIV related activities and services in the country. It addresses all stakeholders from
all constituencies.
The Operational Plan 2008-2010 is composed of the following elements:
1. detailed strategic directions 1 to 13 including the following elements:
a. indicators with targets
b. summary of progress, resource needs and future priorities
c. costed package of services, costs per year and cost component as well as total costs
d. geographical priorities where available
2. a summary budget including expected funding available and gaps in funding
3. the complete monitoring framework, including baseline data, and targets by year.
This Operational Plan is in an achievement of the Technical and Strategy Group for HIV and AIDS (TSG)
and its associated Working Groups:
1. Care, treatment and support working group
2. Drug users working group
3. Executive working group
4. Mobile populations working group
5. Orphans and vulnerable children working group
6. Prevention of mother-to-child transmission working group
7. Sexual transmission working group (Sex workers and men who have sex with men)
8. Youth working group
Furthermore, a peer review of the Operational Plan by the AIDS Strategy and Action Plan (ASAP – hosted
by the World Bank on behalf of UNAIDS) provided useful comments for improvement of the structure and
content of the plan. The reviewers found the operational plan among the best they had seen. Some of the
shortcomings that have been communicated and subsequently addressed are:
• the governance structure is explained
• the monitoring and evaluation framework and the costing parts have been aligned
• the business plan has been reviewed and inconsistencies addressed
• the targets have been reviewed and adapted in the context of past achievements, continuing
constraints and arising opportunities
• costing has been reviewed extensively by the working groups
The operational plan does not include specific activities, since it is intended to provide broad guidance to the
implementers. Likewise, the national, annual targets express approximately the cumulative national
implementation capacity. These fall in many cases short of targets that would be set under an Universal
Access scenario. This reflects the particular funding situation of Myanmar where funding constraints are an
overwhelming challenge to scale up..."

"Thailand has experienced some degree of success in preventing uncontrolled spread of
HIV, and in providing effective care for persons living with HIV/AIDS (PLHA).
Nevertheless, HIV transmission is still occurring, especially among those less fortunate
who migrate to seek economic opportunity. A prime example of this are the lower-income
populations of some of Thailand’s neighbors who come to work on fishing boats or in the
fishery industry of Thailand. The vulnerability of these populations comes from their
relative lack of knowledge and understanding of HIV prevention and tendency to engage
in higher risk sexual behavior than when in their home communities of origin.
To address these vulnerabilities, the Prevention of HIV/AIDS among Migrant Workers in
Thailand Project (PHAMIT) was conceived and implemented by the Raks Thai
Foundation in collaboration with six NGO partners including: Empower Foundation, the
Foundation for AIDS Rights (FAR), World Vision Foundation/Thailand, the Stella Maris
Seafarers Center, the MAP Foundation, and the Pattanarak Foundation. Funding for the
Project was provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria
(GFATM) with the goal to lower the incidence of HIV among foreign migrant workers in
Thailand through communication strategies to reduce risk behaviors and support access
from migrants to general health and reproductive health services. The Project was
implemented during 2003-2008.
In order to independently assess the performance of the PHAMIT Project compared to its
targets and objectives, the Raks Thai Foundation contracted with the Institute for Population
and Social Research (IPSR) of Mahidol University to conduct a final Project evaluation in
2008.
IPSR would like to express its gratitude to Mr. Promboon Panitchapakdi, Executive
Director of the Raks Thai Foundation for entrusting this important evaluation to the
researchers of IPSR. It is our hope that the findings of this evaluation will be of benefit to
the Project implementers, the PHAMIT partners in the field who will continue to deliver the
interventions, and to any persons interested in conducting evaluation research of this type."

This Material is an adaptation of “The Testing and Counseling for Prevention of Mother-to-Child Transmission of HIV (TC for PMTCT) Support
Tools” initially developed by the United States Department of Health and Human Services, Centers for Disease Control and Prevention
(HHS-CDC), Global AIDS Program (GAP), in collaboration with the Department of HIV/AIDS at the World Health Organization (WHO),
the United Nations Children’s Fund (UNICEF), and the United States Agency for International Development (USAID).
This material combines “Antenatal Pre-Test Session Flipchart” and “Antenatal Post-Test Session Flipchart” into one single original document,
available in Burmese as well as in Karen language.
This Flipchart was especially designed and developed to fit the geographical, ethnic and social context of Thai-Burmese border’s refugee
camps.
This adaptation was made under the supervision of AMI (Aide Médicale Internationale) in Mae Sot, Thailand.

This Material is an adaptation of “The Testing and Counseling for Prevention of Mother-to-Child Transmission of HIV (TC for PMTCT) Support
Tools” initially developed by the United States Department of Health and Human Services, Centers for Disease Control and Prevention
(HHS-CDC), Global AIDS Program (GAP), in collaboration with the Department of HIV/AIDS at the World Health Organization (WHO),
the United Nations Children’s Fund (UNICEF), and the United States Agency for International Development (USAID).
This material combines “Antenatal Pre-Test Session Flipchart” and “Antenatal Post-Test Session Flipchart” into one single original document,
available in Burmese as well as in Karen language.
This Flipchart was especially designed and developed to fit the geographical, ethnic and social context of Thai-Burmese border’s refugee
camps.
This adaptation was made under the supervision of AMI (Aide Médicale Internationale) in Mae Sot, Thailand.

Myanmar has one of the most serious HIV epidemics in Asia. Contrary to many perceptions, the response to the epidemic is expanding. Funding for the response has gradually increased over recent years. However, coverage remains unacceptably low, donors seem largely unwilling to inject the resources needed to meet health needs and the government itself significantly under-invests in health.
The National Strategic Plan on AIDS 2006–2010 issued by the Ministry of Health provides the reference framework for the response. Despite what might be expected given the environment, the Plan was developed in a participatory fashion, is multi-sectoral and up to date and prioritises service provision for the most at-risk populations. It is supported by a government-led, inclusive technical coordination group. However, significant barriers to service provision exist. These include constraining administrative procedures, controlled access, limited research and a highly politicised context. Nevertheless, the results demonstrate that persistent negotiation can yield agreements resulting in increased services for those in need. Nearly 40 international and national NGOs are implementing successful activities in Myanmar, alongside government efforts and with UN support.

Executive Summary: The situation for many people living with HIV in Myanmar is critical due to a severe lack of lifesaving antiretroviral treatment (ART). MSF currently provides ART to more than 11,000 people. That is the majority of all available treatment countrywide but only a small fraction of what is urgently needed. For five years MSF has continually developed its HIV/AIDS programme to respond to the extensive needs, whilst the response of both the Government of Myanmar and the international community has remained minimal. MSF should not bear the main responsibility for one of Asia’s most serious HIV/AIDS epidemics. Pushed to its limit by the lack of other services providing ART, MSF has had to make the painful
decision to restrict the number of new patients it can treat. With few options to refer new patients for treatment elsewhere, the situation is dire.
An estimated 240,000 people are currently infected with HIV in Myanmar. 76,000 of these people are in urgent need of ART, yet less than 20 % of them receive it through the combined efforts of MSF, other international non-governmental organizations (NGOs) and the Government of Myanmar.
For the remaining people the private market offers little assistance as the most commonly used first-line treatment costs the equivalent of a month’s average wage. The lack of accessible treatment resulted in 25,000 AIDS related deaths in 2007 and a similar number of people are expected to suffer the same fate this year, unless HIV/AIDS services - most importantly the provision of ART - are urgently scaled-up.
The Government of Myanmar and the International Community need to mobilize quickly in order to address this situation. Currently,
the Government spends a mere 0.3% of the gross domestic product on health, the lowest amount worldwide4, a small portion of which goes to HIV/AIDS. Likewise, overseas development aid for Myanmar is the second lowest per capita worldwide and few of the big international donors provide any resources to the country. Yet, 189 member states of the United Nations, including
Myanmar, endorsed the Millennium Development Goals, including the aim to “Achieve universal access to treatment for HIV/AIDS for all those who need it, by 2010”. As it stands, this remains a far cry from becoming a reality in Myanmar. As an MSF ART patient in Myanmar stated, “All people must have a spirit of humanity in helping HIV patients regardless of nation, organization or government. We are all human beings so we must help each other”. Unable to continue shouldering the primary responsibility for responding to one of Asia’s worst HIV crises,
MSF insists that the Government of Myanmar and international organizations
urgently and rapidly scale-up ART provision. A vast gulf exists between the needs related to HIV/AIDS and the services provided. Unless ART provision is rapidly scaled-up many more people will needlessly suffer and die.

"Reducing HIV/AIDS prevalence in Burma1 (Myanmar) presents a significant
challenge for international aid agencies and donors. Ruled by a succession of military
regimes since 1962, Myanmar faces a growing humanitarian crisis with the second
worst health system in the world (World Health Organization). Weak state capacity
exacerbates the country!s health dilemmas. However, the government!s lack of
domestic and international legitimacy makes harmonizing projects to improve state
capacity politically sensitive and logistically arduous. Burma!s difficult operating
environment has even made it the only country from which the Global Fund to fight
AIDS, Tuberculosis, and Malaria has withdrawn its programs.2
Yet the extent of the AIDS epidemic in the country underlies the need to
structure aid programs to work within the restrictive context and mitigate further
disaster. Given the country!s intractable political situation, what lessons can be learned
from international HIV/AIDS programs that have not only sustained but also expanded
their efforts in Burma? This paper draws from over ten months of ethnographical
interviews with aid workers, field visits to project sites in Yangon and its surrounding
villages, and a literature review on humanitarian aid to fragile states. The problems of
corruption, weak bureaucratic structure, restrictions on aid flows, inability to
appropriately monitor programs, and capricious governmental policies have been well
documented in Burma. However, there is little mention in the existing literature of how
programs have managed to deliver aid in the face of the various constraints.
Particularly missing from the standard analysis is how the national staff of aid
organizations interact with local governmental authorities to expand the humanitarian
space in which to operate. By focusing on the perceptions of field staff and the
practical methods of aid delivery, this paper presents an embedded view of HIV/AIDS
programs in Burma..."

The handing over of money to the international NGOs, UN agencies, Burma's government (I use the term loosely) and the Burmese NGOs does not mean that the resources are used effectively and efficiently for the people of Burma. Uncovering the performance of aid - that is its cost effectiveness and its impact on the intended recipients is not necessarily an easy task. It is also a task made more difficult by the poor quality of the information generally provided by the donors and the recipient organisations.

JAPAN International Cooperation is leading the fight against three major diseases in Myanmar. The Myanmar Times’ Khin Myat met with JICA project leader and tuberculosis specialist, Mr Kosuke Okada, and malaria expert Mr Masatoshi Nakamura to ask about their activities.
1. How much money is JICA spending annually to control these diseases?
Our project period is from January 2005 to January 2010. We have been spending around ¥150 million per year on long- and short-term experts, international and domestic training, provision of equipment such as vehicles, lab equipment, microscopes, mosquito nets, lab test kits, local training and consumables.

Conclusion: "Boatmen in Teknaf are an integral part of a high-risk sexual behaviour
network between Myanmar and Bangladesh. They are at risk of obtaining HIV infection
due to cross border mobility and unsafe sexual practices. There is an urgent need for
designing interventions targeting boatmen in Teknaf to combat an impending epidemic of
HIV among this group. They could be included in the serological surveillance as a
vulnerable group. Interventions need to address issues on both sides of the border, other
vulnerable groups, and refugees. Strong political will and cross border collaboration is
mandatory for such interventions."

Abstract:
"Decades of neglect and abuses by the Burmese government have decimated the health of the
peoples of Burma, particularly along her eastern frontiers, overwhelmingly populated by
ethnic minorities such as the Shan. Vast areas of traditional Shan homelands have been
systematically depopulated by the Burmese military regime as part of its counter-insurgency
policy, which also employs widespread abuses of civilians by Burmese soldiers, including
rape, torture, and extrajudicial executions. These abuses, coupled with Burmese government
economic mismanagement which has further entrenched already pervasive poverty in rural
Burma, have spawned a humanitarian catastrophe, forcing hundreds of thousands of ethnic
Shan villagers to flee their homes for Thailand. In Thailand, they are denied refugee status
and its legal protections, living at constant risk for arrest and deportation. Classified as
“economic migrants,” many are forced to work in exploitative conditions, including in the
Thai sex industry, and Shan migrants often lack access to basic health services in Thailand.
Available health data on Shan migrants in Thailand already indicates that this population
bears a disproportionately high burden of infectious diseases, particularly HIV, tuberculosis,
lymphatic filariasis, and some vaccine-preventable illnesses, undermining progress made by
Thailand’s public health system in controlling such entities. The ongoing failure to address
the root political causes of migration and poor health in eastern Burma, coupled with the
many barriers to accessing health programs in Thailand by undocumented migrants,
particularly the Shan, virtually guarantees Thailand’s inability to sustainably control many
infectious disease entities, especially along her borders with Burma."

Abstract:
"Myanmar is experiencing an HIV epidemic documented since the late
1980s. The National AIDS Programme national surveillance ante-natal
clinics had already estimated in 1993 that 1.4% of pregnant women
were HIV positive, and UNAIDS estimates that at end 2005 1.3%
(range 0.7-2.0%) of the adult population was living with HIV. While a
HIV surveillance system has been in place since 1992, the
programmatic response to the epidemic has been slower to emerge
although short- and medium-terms plans have been formulated since
1990. These early plans focused on the health sector, omitted key
population groups at risk of HIV transmission and have not been
adequately funded. The public health system more generally is
severely under-funded.
By the beginning of the new decade, a number of organisations had
begun working on HIV and AIDS, though not yet in a formally
coordinated manner. The Joint Programme on AIDS in Myanmar 2003-
2005 was an attempt to deliver HIV services through a planned and
agreed strategic framework. Donors established the Fund for HIV/AIDS
in Myanmar (FHAM), providing a pooled mechanism for funding and
2
significantly increasing the resources available in Myanmar. By 2006
substantial advances had been made in terms of scope and diversity of
service delivery, including outreach to most at risk populations to HIV.
More organisations provided more services to an increased number of
people. Services ranged from the provision of HIV prevention
messages via mass media and through peers from high-risk groups, to
the provision of care, treatment and support for people living with HIV.
However, the data also show that this scaling up has not been
sufficient to reach the vast majority of people in need of HIV and AIDS
services.
The operating environment constrains activities, but does not, in
general, prohibit them. The slow rate of service expansion can be
attributed to the burdens imposed by administrative measures,
broader constraints on research, debate and organizing, and
insufficient resources. Nevertheless, evidence of recent years
illustrates that increased investment leads to more services provided
to people in need, helping them to obtain their right to health care.
But service expansion, policy improvement and capacity building
cannot occur without more resources."

HIV/AIDS education efforts face many obstacles...
"Gasps rippled through the group of young people gathered for a workshop on HIV/AIDS prevention and education in the former capital Rangoon. The girls covered their eyes, and the boys sent nervous glances anywhere but at the front of the room, where an instructor stood before an upright model penis.
Condoms on sale at a market stall in Rangoon [Photo: Pat Brown]
“Look at it, please,” the workshop leader urged. “How can you learn to protect yourself against HIV if you are too shy to watch a demonstration about how to use a condom?”
This kind of response to condom education is typical in Burma, where an estimated 360,000 people currently live with HIV, according to a UNAIDS report in 2006.
Today, condoms can be easily obtained in retail shops in Rangoon and other major cities in Burma. But the country’s predominantly conservative culture can make them a difficult sell.
“I don’t sell condoms in my store any more because many of my staff are young girls who find it difficult to sell them,” said a shop owner in Kyeemyindaing..."

"Decades of repressive military rule, civil war, corruption, bad governance, isolation, and
widespread violations of human rights and international humanitarian law have rendered
Burma’s health care system incapable of responding effectively to endemic and emerging
infectious diseases. Burma’s major infectious diseases—malaria, HIV/AIDS, and tuberculosis
(TB)—are severe health problems in many areas of the country. Malaria is the most common
cause of morbidity and mortality due to infectious disease in Burma. Eighty-nine percent of the
estimated population of 52 million lived in malarial risk areas in 1994, with about 80 percent of
reported infections due to Plasmodium falciparum, the most dangerous form of the disease.
Burma has one of the highest TB rates in the world, with nearly 97,000 new cases detected each
year.4 Drug resistance to both TB and malaria is rising, as is the broad availability of counterfeit
antimalarial drugs. In June 2007, a TB clinic operated by Médecins Sans Frontières–France in
the Thai border town of Mae Sot reported it had confirmed two cases of extensively drugresistant
TB in Burmese migrants who had previously received treatment in Burma. Meanwhile,
HIV/AIDS, once contained to high-risk groups in Burma, has spread to the general population,
which is defined as a prevalence of 1 percent among reproductive-age adults.5
Meanwhile, the Burmese government spends less than 3 percent of national expenditures on
health, while the military, with a standing army of over 400,000 troops, consumes 40 percent.6
By comparison, many of Burma’s neighbors spend considerably more on health: Thailand
(6.1%7), China (5.6 %8), India (6.1%9), Laos (3.2%10), Bangladesh (3.4%11), and Cambodia
(12%12).....The report recommends that:
• The Burmese government develop a national health care system in which care is
distributed effectively, equitably, and transparently.
• The Burmese government increase its spending on health and education to confront
the country’s long-standing health problems, especially the rise of drug-resistant
malaria and tuberculosis.
• The Burmese government rescind guidelines issued last year by the country’s
Ministry of National Planning and Economic Development because these guidelines
have restricted such organizations as the International Committee of the Red Cross
(ICRC) from providing relief in Burma.
• The Burmese government allow ICRC to resume visits to prisoners without the
requirement that ICRC doctors be accompanied by members of the Union Solidarity
and Development Association or other organizations.
• The Burmese government take immediate steps to halt the internal conflict and
violations of international human rights and humanitarian law in eastern Burma that
are creating an unprecedented number of internally displaced persons and facilitating
the spread of infectious diseases in the region.
• Foreign aid organizations and donors monitor and evaluate how aid to combat
infectious diseases in Burma is affecting domestic expenditures on health and
education.
• Relevant national and local government agencies, United Nations agencies, NGOs
establish a regional narcotics working group which would assess drug trends in the
region and monitor the impact of poppy eradication programs on farming
communities.
• UN agencies, national and local governments, and international and local NGOs
cooperate closely to facilitate greater information-sharing and collaboration among
agencies and organizations working to lessen the burden of infectious diseases in
Burma and its border regions. These institutions must develop a regional response
to the growing problem of counterfeit antimalarial drugs."

"Opium poppy has been cultivated in Myanmar for more than a century. Farmers
have traditionally relied on its cultivation to offset rice deficits and to purchase
basic goods. Opium has also been used as a painkiller and to alleviate the
symptoms associated with diarrhoea, cough and other ailments. Additionally, the
use of opium as medicine is often exacerbated by the lack of access to health
care services.
As the production and consumption of
drugs are often linked, opiates remain
the most widely used illicit drug within
the country, with approximately an even
split between heroin and opium use. In
recent years, however, there appears
to be a trend away from the traditional
smoking of opium to injecting heroin.
Moreover, the use of Amphetamine-
Type Stimulants (ATS), especially by young people, is rapidly increasing.
Drug use is considered in many countries as a criminal offence, often driving it
underground, where users remain hidden and unmonitored. The stigma and
marginalisation frequently experienced by drug users often means that they are
excluded from access to medical services.
The consequences of drug use on society are
numerous and include, adverse effects on
health; crime, violence and corruption;
draining of human, natural and financial
resources that might otherwise be used for
social and economic development; erosion of
individual, family and community ties; and
undermining of political, cultural, social and
economic structures.
The situation is made even more critical by the economic hardships many drug
users experience. This is certainly the case in Myanmar. In addition, injecting drug
use and the sharing of equipment is an extremely high-risk behaviour in relation
to HIV transmission..."

Language:

English

Source/publisher:

United Nations Office on Drugs and Crime (UNODC) - Myanmar Country Office

Executive Summary:
"The HIV epidemics in Myanmar remain
largely concentrated among people identified with
high-risk behaviours, in particular sex workers
and their clients, injecting drug users and men
having sex with men; and populations identified
as highly vulnerable on the basis of their young
age, gender, mobility and social or occupational
characteristics. This focus of the epidemics calls for
the urgent strengthening of prevention, care and
treatment programmes addressing primarily the
needs of these populations. The responses to the
HIV epidemic to date have been diverse and great
sources of learning, and demonstrated the capacity
to respond to the HIV epidemic successfully in
Myanmar, but are not being implemented to a
scale sufficiently enough to slow down the epidemic
or mitigate its impact.
Confronting an unabated HIV epidemic,
the Government of Myanmar decided to
embark on a comprehensive prevention, care and
treatment strategy which would build on the
experience and enrol the participation of all actors
committed to this goal. Accordingly, this National
Strategic Plan was the first in Myanmar developed
using participator y processes, with direct
involvement of all sectors involved in the national
response to the HIV epidemic. Contributions were
made by the Ministry of Health, several other
government ministries, United Nations entities,
local non-government organizations, international
non-government organizations, people living with
HIV and people from vulnerable groups. The
National Strategic Plan 2006 â“ 2010 was
prepared following a series of reviews which looked
at the progress and experiences of activities during
the first half of the decade. These included a midterm
review of the Joint Programme for HIV/
AIDS in 2005 and a review of the National
AIDS Programme in 2006, as well as many
diverse studies and reviews of particular
programmes and projects. The National Strategic
Plan identifies what is now required to improve
national and local responses, bring partners together
to reinforce the effectiveness of all responses, and
build more effective management, coordination,
monitoring and evaluation mechanisms. It builds
on current responses, identifies initiatives which
are working and need to be scaled up to have
maximum impact, builds on key principles which
will underline the national response, outlines
broadly the approaches to be used for prevention,
treatment, care and support, and delineates strategic
directions and activity areas to be further developed
in order to mitigate the impact of the epidemic.
Ambitious service delivery targets have been set,
aiming towards ' to prevention
and care services.
The National Strategic Plan is
composed of two parts: Part One, presenting
background information, aim, objectives, key
principles, strategic directions, approaches and
information on roles of participating entities and
coordinating mechanisms; and Part Two,
presenting, for each strategic direction activity area,
outcomes, outputs, indicators and targets. The
subsequent formulation of a Plan of Operations
and accompanying budgets will translate key
principles and broad directions set out in the strategic
plan into a directly actionable and costed plan
relevant to all aspects of the national response to
HIV and to all partners in this unprecedented
effort.
Building on previous experiences and
lessons learned by all partners about what
works best in the specific context of Myanmar,
the National Strategic Plan identifies the key
principles underpinning both the plan itself and its future implementation. Among these are: the
adherence to the "Three Ones" principles â“ One
HIV and AIDS Action Framework; one
National Coordinating Authority; and one
Monitoring and Evaluation System â“ the
participation of people living with HIV in every
aspect and at every stage of the strategy, a primary
emphasis on outcomes, defined as targeted
behaviour changes and use of services; and a focus
on the Township level with selected "Accelerated
Townships" receiving support towards accelerated
programme implementation. Key principles bring
into focus populations at higher risk and
vulnerability and with the greatest needs, ensuring
that their needs are met to the maximum extent
possible and that their participation in activities
concerning them is secured. The development and
implementation of an enabling environment is
central to this approach, recognizing the negative
effects that lack of information, inequality,
discrimination and non-participation have on the
reduction of HIV related risk and vulnerability.
The strategy will strive to scale up programme
coverage and use of services to the maximum
achievable levels of resource availability and
implementing capacity. It will build on evidence as
strategic information guides decision and action
and will achieve value for money as financial and
other resources are incrementally mobilized and
efficiently used. Working across sectors of
government will gradually expand as capacity
is built. The strategy will rely on collaboration
between government and other public, private
and non-government entities while
mechanisms for coordination at the central
and peripheral levels are enhanced.
The National Strategic Plan for
Myanmar aims at reducing HIV transmission
and HIV related morbidity, mortality, disability
and social and economic impact. Its objectives are
to: reduce HIV transmission and vulnerability,
particularly among people at highest risk; improve
the quality and length of life of people living with
HIV through treatment, care and support; and
mitigate the social, cultural and economic impacts
of the epidemic.
Strategic directions are primarily defined
on the basis of beneficiary populations. They
include the reduction of HIV-related risk,
vulnerability and impact among sex workers and
their clients, men who have sex with men, drug
users, partners and families of people living with
HIV, institutionalized populations, mobile
populations, uniformed services personnel, young
people, individuals in the workplace and, more
generally, men and women of reproductive age. They
strive to meet the needs of people living with HIV
for comprehensive care, support and treatment
through the scaling up of services and use of a
participatory approach. In order to expand
the ability of all actors to engage fully in this
collaborative effort, strategic directions also include
the enhancement of the capacity of health systems
and the strengthening of comprehensive monitoring
and evaluation mechanisms.
This National Strategic Plan is a
living document: it lends itself to adjustments and
revisions as further experience is gained, resources
are mobilized and evidence of success and
shortcomings is generated through monitoring,
special studies and mid-term and end-of-term
evaluations."

EXECUTIVE SUMMARY:
"...[T]his
assessment examines mobility and HIV vulnerability among Myanmar migrants in Mae
Sot District, Tak Province, Thailand. Environmental and social factors, service access,
knowledge, and behavioural vulnerabilities, along with gender issues, stigma and
discrimination, are addressed.
Undertaken from December 2005 through April 2006, this assessment aims to assist the
Royal Thai Government (RTG) and partners to develop more effective policies and
programmes for preventing HIV transmission, and to improve access to HIV and AIDS
treatment and care among selected Myanmar migrants.
The assessment team employed a collaborative qualitative and quantitative research
approach to assess HIV vulnerability among migrant sex workers and migrant factory
workers. A total of six focus group discussions were conducted with both direct and
indirect sex workers, while six and four focus group discussions were conducted with
male and female factory workers respectively. Eight individual interviews with direct and
indirect sex workers were completed. Key informants and gatekeepers were consulted
and snowball sampling was used to establish the appropriate groups or individuals for
interview. The quantitative component of the assessment was designed using probability
proportionate to size (PPS) sampling methodology, and a pre-tested questionnaire was
consequently administered to 819 migrant factory workers between the ages of 15 and 49
in 12 factories in Mae Sot District. There were 312 male and 507 female respondents, all
of Myanmar origin.
Through the research, the assessment team learned that migrants arrive in Thailand with
little or no knowledge about HIV/AIDS and sexual health, and in some cases basic
knowledge of reproductive health. Though training and outreach programmes have
reached some of the factory worker and sex worker populations, knowledge remains at a
very basic level and is predominantly disseminated by friends and siblings who attended
various trainings. The qualitative and quantitative findings show that most of those
demonstrating some knowledge of HIV/AIDS were merely reiterating what was
disseminated during the outreach. Important knowledge and some behavioural gaps
persist.
From as far as Sagaing in central Myanmar to just across the bridge in Myawaddy,
migrants working at the factories of Mae Sot District are from diverse areas within
Myanmar. The largest numbers, however, are from Mawlamyaing and Bago in Kayin
State, in the eastern region of Myanmar.
The driving forces behind the migration of the predominantly rural Myanmar population
to Mae Sot District include financial difficulties back home due to debt, death or
sickness, and the hope for a better life in the future.
1
Some of those who arrive in Myawaddy are brought to the Thai side of the border
through the employment of “carriers” or brokers (commonly referred to as gae-ri in
Bamar or nai nah in Thai), who offer migrants job placement opportunities that would
otherwise be almost impossible to achieve without a contact. Under such schemes, female
migrants are particularly vulnerable to exploitation. There is evidence to suggest that
brokers provide the initial capital for the women to migrate to Thailand and then sell
them to a karaoke bar or brothel. The women are then bound to work off the amount of
money that was paid by the brothel to the broker.
Though factory work is certainly the most sought after type of employment, it is not
consistently available. Many migrants are forced to wait several months for positions or
find other endeavours as day labourers, farmhands, construction workers or housemaids,
or simply return home.
The ultimate goal for the majority of migrants working in Thailand is to accumulate
enough capital to eventually return home to family and friends and use that capital for
commercial pursuits. Should such pursuits fail, the individual often considers returning to
Thailand.
Sex workers are vulnerable to HIV primarily due to the high risk of their profession.
Indirect sex workers (those working out of a karaoke bar, restaurant or freelance) are
particularly vulnerable because information and services do not reach them. Conversely,
factory workers demonstrated little vulnerability to HIV due to their sparse amount of
free time, restriction of movement outside the factory compound, lack of extramarital
sex, conservative social values and lack of disposable income. Their lack of knowledge
with respect to HIV/AIDS and sexual health, however, creates some vulnerability. These
findings could be confirmed by results from studies in other provinces/countries with
migrants from other countries such as Lao PDR.
Efforts need to be increased to provide culturally appropriate HIV/AIDS and sexually
transmitted infection (STI) information to migrants, using strategies that facilitate
analysis of personal risk perception. Health-care providers require improved sensitivity to
the basic needs of migrants, including respect for confidentiality in the clinical setting.
The importance of the public sector in providing STI, HIV and reproductive health
services to migrants cannot be overemphasized. Migrants express a clear preference for
STI treatment in the public health sector because they can better remain anonymous in
the clinical Thai setting. Many direct sex workers (brothel-based sex workers) are already
assisted through regular check-ups at Mae Sot General Hospital. Factory workers and sex
workers involved in the study trust government health-care providers over nongovernmental
organizations (NGOs) and community-based organizations. Great impact
can be made by strengthening collaboration between government health-care providers
and both the private sector and the migrants themselves. Migrant community health
workers working under the direction of the health authorities can be an effective
mechanism (e.g., the IOM-Ministry of Public Health [MOPH] Migrant Health
2
Programme model). Sensitivity, confidentiality and communication skills of public sector
health-care providers should be strengthened for improved impact.
Moreover, existing programmes (e.g., the hospital’s STI clinic) could be strengthened to
ensure that migrants receive appropriate referral to an array of government and NGO
services locally available. During the study it was clear that the agencies working on
HIV-related programmes are neither communicating regularly nor cooperating effectively
with one another. A strengthened coordination mechanism is warranted wherein
government, NGO, and private sector stakeholders can improve transparency, share
materials and information, strengthen referral networks and create improved working
relationships.
Although the study faced several obstacles, particularly regarding issues on access to
targeted populations which affected the representativeness of the study sampling, the
research team had used the best of their knowledge and skills in minimizing the study
bias. It is the hope of the assessment team that the information contained within this
study will assist in informing policy makers and implementers in improving STIs/HIV
programmes for migrants in Mae Sot District and elsewhere in Thailand.

"Although political sanctions preclude Burma from consistent
international financial contributions to HIV/AIDS,
the first program to access ARV drugs for the HIV+/AIDS
patients in the public sector has been funded by a private
company: Yadana (Total and partners) and implemented
by an international NGO: the International Union
Against Tuberculosis and Lung Disease (IUTLD) also
called "The Union". The World Health Organization
(WHO) and the Ministry of Health of Myanmar support
this program. It started April 1st, 2005 at the General Hospital
(MGH) of Mandalay the second largest city of the
country where 7000 HIV+ patients are estimated to be in
need of ARVs...."

"The delivery of humanitarian assistance in Burma/Myanmar is facing new threats. After a period in which humanitarian space expanded, aid agencies have come under renewed pressure, most seriously from the military government but also from pro-democracy activists overseas who seek to curtail or control assistance programs. Restrictions imposed by the military regime have worsened in parallel with its continued refusal to permit meaningful opposition political activity and its crackdown on the Karen. The decision of the Global Fund for AIDS, Tuberculosis and Malaria to withdraw from the country in 2005 was a serious setback, which put thousands of lives in jeopardy, although it has been partly reversed by the new Three Diseases Fund (3D Fund). There is a need to get beyond debates over the country's highly repressive political system; failure to halt the slide towards a humanitarian crisis could shatter social stability and put solutions beyond the reach of whatever government is in power..."

"1. Introduction
The Operational Plan 2006 -2009 was developed following the development of the National Strategic Plan 2006 – 2010.
The Operational Plan, using the National Strategic Plan as a guide for decisions on priorities and scaling up, provides a range of products associated with the planning, monitoring and implementation that require the input and involvement of many different stakeholders. A NSP flow-chart has been developed to clearly identify the steps, timing, and actors responsible for leading and/or being involved in processes (cf annex).
A training workshop was conducted in April 2006 on estimation of resources need and provisional rapid costing for resource mobilization. As a result, yearly targets and estimated cost of each component and sub-component of the strategic plan 2006 - 2010 were formulated. A core team of experts for the same to undertake future costing work was also formed.
The Operational Plan incorporates all existing resources. The three year Operational Planning Cycle aims to encourage longer term financing. Each year, the immediately forthcoming year will be developed in greater detail to ensure coordination, identify specific actors and geographical areas, assess key enabling environment issues which need to be addressed, and better plan financial flows. The annual review of a three-year rolling plan thus balances the desire for longer-term financing with the need for annual review of progress, changing conditions and more detailed planning.
Funding for Year 1 (April 2006 to March 2007) includes existing resources from the Global Fund and the FHAM which are mostly available up to December 2006. Funding to fill the gaps will be sought from a variety of sources, including increased domestic contributions, pooled donor mechanisms such as the 3-Diseases Humanitarian Fund for Myanmar, bilateral development agencies and other sources.
The Operational Plan is composed of a set of documents, including:
• description of the strategic directions and indicators with targets, including scaling-up and geographical priorities
• business plan and budget
• Monitoring and Evaluation Framework."

Executive Summary:
"The HIV epidemics in Myanmar remain largely concentrated among people identified with
high-risk behaviours, in particular sex workers and their clients, injecting drug users and men
having sex with men; and populations identified as highly vulnerable on the basis of their
young age, gender, mobility and social or occupational characteristics. This focus of the
epidemics calls for the urgent strengthening of prevention, care and treatment programmes
addressing primarily the needs of these populations. The responses to the HIV epidemic to
date have been diverse and great sources of learning, and demonstrated the capacity to
respond to the HIV epidemic successfully in Myanmar, but are not being implemented to a
scale sufficient to slow down the epidemic or mitigate its impact.
Confronting an unabated HIV epidemic, the Government of Myanmar decided to embark on a
comprehensive prevention, care and treatment strategy which would build on the experience
and enrol the participation of all actors committed to this goal. Accordingly, this National
Strategic Plan was the first in Myanmar developed using participatory processes, with direct
involvement of all sectors involved in the national response to the HIV epidemic.
Contributions were made by the Ministry of Health, several other government ministries,
United Nations entities, local non-government organizations, international non-government
organizations, people living with HIV and people drawn from vulnerable groups. The
National Strategic Plan 2006 – 2010 was prepared following a series of reviews which looked
at the progress and experiences of activities during the first half of the decade. These included
a mid-term review of the Joint Programme for HIV/AIDS in 2005 and a review of the
National AIDS Programme in 2006, as well as many diverse studies and reviews of particular
programmes and projects. The National Strategic Plan identifies what is now required to
improve national and local responses, bring partners together to reinforce the effectiveness of
all responses, and build more effective management, coordination, monitoring and evaluation
mechanisms. It builds on current responses, identifies initiatives which are working and need
to be scaled up to have maximum impact, builds on key principles which will underlie the
national response, outlines broadly the approaches to be used for prevention, treatment, care
and support, and delineates strategic directions and activity areas to be further developed in
order to mitigate the impact of the epidemic. Ambitious service delivery targets have been set,
aiming towards Universal Access’ to prevention and care services.
The National Strategic Plan is composed of two parts: Part One, presenting background
information, aim, objectives, key principles, strategic directions, approaches and information
on roles of participating entities and coordinating mechanisms; and Part Two, presenting, for
each strategic direction activity area, outcomes, outputs, indicators and targets. The
subsequent formulation of a Plan of Operations and accompanying budgets will translate key
principles and broad directions set out in the strategic plan into a directly actionable and
costed plan relevant to all aspects of the national response to HIV and to all partners in this
unprecedented effort.
Building on previous experiences and lessons learned by all partners about what works best in
the specific context of Myanmar, the National Strategic Plan identifies the key principles
underpinning both the plan itself and its future implementation. Among these are: the
adherence to the “Three Ones” principles – One HIV and AIDS Action Framework; one
National Coordinating Authority; and one Monitoring and Evaluation System – the
participation of people living with HIV in every aspect and at every stage of the strategy, a
primary emphasis on outcomes, defined as targeted behaviour changes and use of services;
and a focus on the Township level with selected “Accelerated Townships” receiving support
towards accelerated programme implementation. Key principles bring into focus populations
at higher risk and vulnerability and with the greatest needs, ensuring that their needs are met
to the maximum extent possible and that their participation in activities concerning them is
secured. The development and implementation of an enabling environment is central to this
approach, recognizing the negative effects that lack of information, inequality, discrimination
and non-participation have on the reduction of HIV-related risk and vulnerability. The
strategy will strive to scale up programme coverage and use of services to the maximum
achievable levels of resource availability and implementing capacity. It will build on evidence
as strategic information guides decision and action and will achieve value for money as
financial and other resources are incrementally mobilized and efficiently used. Working
across sectors of government will gradually expand as capacity is built. The strategy will rely
on collaboration between government and other public, private and non-government entities
while mechanisms for coordination at the central and peripheral levels are enhanced.
The National Strategic Plan for Myanmar aims at reducing HIV transmission and HIV-related
morbidity, mortality, disability and social and economic impact. Its objectives are to: reduce
HIV transmission and vulnerability, particularly among people at highest risk; improve the
quality and length of life of people living with HIV through treatment, care and support; and
mitigate the social, cultural and economic impacts of the epidemic.
Strategic directions are primarily defined on the basis of beneficiary populations. They
include the reduction of HIV-related risk, vulnerability and impact among sex workers and
their clients, men who have sex with men, drug users, partners and familes of people living
with HIV, institutionalized populations, mobile populations, uniformed services personnel,
young people, individuals in the workplace and, more generally, men and women of
reproductive age. They strive to meet the needs of people living with HIV for comprehensive
care, support and treatment through the scaling up of services and use of a participatory
approach. In order to expand the ability of all actors to engage fully in this collaborative
effort, strategic directions also include the enhancement of the capacity of health systems and
the strengthening of comprehensive monitoring and evaluation mechanisms.
This National Strategic Plan is a living document: it lends itself to adjustments and revisions
as further experience is gained, resources are mobilized and evidence of success and
shortcomings is generated through monitoring, special studies and mid-term and end-of-term
evaluations."

Various statistics, including prevention of mother-child transmission of HIV; Number of HIV+ pregnant women receiving
ARVs for PMTCT; Number of children in need receiving ART...
UNICEF, WHO and UNAIDS, Children and AIDS: Country fact sheets

The national adult prevalence of HIV infection is between 1% to 2%. Myanmar is thus characterized as having a "generalized" epidemic. However, the
spread of the HIV infection across the country is heterogenous varying widely by geographical location and by population sub group.
HIV was introduced in Myanmar in mid-to-late 1980s and by the end of 2003, a cumulative 7,174 AIDS cases and 3,324 AIDS deaths have been
reported. The male-to-female ratio among reported cases is 3.6:1. Among cases with known mode of transmission, 65% acquired infection by
heterosexual route, 26% by injecting drug use, and 5% by contaminated blood. ....

RANGOON, Burma -- Dada would have killed herself but she couldn't afford a proper burial.
An orphan with a broad, sweet face and downcast eyes, she recalled the horror of learning two years ago that she had HIV. She had been a prostitute since she was 15 and hadn't saved enough for even a simple funeral, which according to her belief as a Buddhist was vital to reincarnation into a better life. So Dada kept on living.
Now, at age 23, it is what is left of this life that frightens her. Friends and other prostitutes have begun wasting away from AIDS, unable to pay the staggering cost of antiretroviral drugs, and Dada admits with an awkward giggle that she expects the same fate.
"I have no husband. I have no family," she whispered. "I have to stand on my own feet all by myself."
The secretive Burmese government had long denied that this country had a major AIDS problem, but international health experts now say it is among the worst in Asia. With antiretroviral drugs for AIDS costing about 10 times a teacher's monthly salary, few Burmese can pay for them. Fewer than 5 percent of those who need the drugs can get them free from the government and international agencies, according to U.N. estimates.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, a Geneva-based foundation, had planned to expand funding to triple the number of HIV-positive people receiving subsidized medication. But in August, it canceled a program to fight the three diseases in Burma and ended $87 million in funding, because of new restrictions imposed by the military government on travel and the import of medical supplies.

Foreword:
I Introduction...
II Context:
Overview of the epidemic in Myanmar...
III Programme Achievements:
Highlights in achievements -
1 Access to services to prevent the sexual transmission of HIV improved;
2 Access to services to prevent IDU transmission of HIV improved;
3 Knowledge and attitudes improved;
4 Access to services for HIV care and support improved;
5 Enabling environment and capacity building...
IV Coordination, Harmonisation and Monitoring & Evaluation:
Governance and Coordination;
Monitoring and Evaluation...
V FHAM Resources and Operational Issues:
Financial resources;
Operational issues...
Conclusion...
Annexe 1: FHAM budget overview...
Annexe 2: FHAM Summary of technical progress...
Annexe 3: Achievements by FHAM implementing partners...
Annexe 4: Round II of the FHAM (FY 2004-05): Budget, expenditure and
utilisation by implementing partners."...This report covers progress under both the Joint Programme and the Fund for HIV/AIDS in
Myanmar because the two are so closely linked. It covers the calendar years 2003 and 2004
for the Joint Programme, and the second financial year for the FHAM, 2004 (1st April 2004 ÃÂ¢Ã¯Â¿Â½Ã¢ï¿½Å“
31st March 2005). As all of the activities are ongoing, in some cases key events or
achievements which have occurred later in 2005 ÃÂ¢Ã¯Â¿Â½Ã¢ï¿½Å“ strictly speaking outside the reporting
period ÃÂ¢Ã¯Â¿Â½Ã¢ï¿½Å“ have been mentioned.
In April and May 2005, the Country Coordinating Mechanism in Myanmar prepared a proposal
for the 5th Round of the Global Fund. This proposal mobilised more actors and resulted in
probably the best Global Fund proposal to date. Much of the information that went into the
proposal has been used and borrowed and is presented here, to ensure that the work that
went into the analysis for the Global Fund receives a broader hearing.
Also in May, 2005, the Joint Programme underwent a three week, independent, external
review. In preparation for this process, each of the five thematic Component Groups prepared
pre-Review briefing papers which highlighted progress and identified key issues. These pre-
Review papers have also informed this report, and the time and efforts of individuals who
worked on them are hereby acknowledged. The Mid Term Review itself is contributing to a
process of reflection and reorganisation, which will result in a Joint Programme document for
2006 and beyond, along with a resource mobilisation drive for the FHAM.
And finally some words on the mobilisation of new resources for AIDS in Myanmar. The
concerning news of course is that the Global Fund grants for tuberculosis, malaria and AIDS
have been terminated, leaving a gap in resources which the FHAM and other sources will be
required to fill. The good news is that the Government of the Netherlands in July 2005
indicated it will contribute ÃÂ¯ÃÂ¿ÃÂ½4m to the FHAM, ÃÂ¯ÃÂ¿ÃÂ½1m for each of the years 2005-08. This brings
to four the number of donors contributing to the FHAM - in addition to the United KingdomÃÂ¢Ã¯Â¿Â½Ã¢ï¿½Â¢s
Department for International Development (DFID), SwedenÃÂ¢Ã¯Â¿Â½Ã¢ï¿½Â¢s Agency for International
Development Cooperation (SIDA), and the Norwegian Government - and provides the first
concrete funding commitment for the next cycle of programming.
This report demonstrates that it is possible to deliver humanitarian assistance in Myanmar, and
will, I hope, encourage donors to consider making such necessary investments in the fight
against AIDS for the people of Myanmar."...Of the 2 versions the smaller one, the pre-publication version, has no photos but, as far as I can see from a brief comparison, the text is more or less the same.

TABLE OF CONTENTS:
Acknowledgements;
Executive Summary;
Summary of mid-term review findings and recommendations;
Background;
HIV/AIDS situation and response in Myanmar;
Challenges to mobilising a response;
Review methodology;
Progress against Joint Programme outputs;;
Output 1;
Output 2;
Output 3;
Output 4;
Output 5;
Responses to additional questions in the TORs;
Table 1: HIV sentinel surveillance results among IDUs, 1992-2003 10;
Table 2: Numbers of clients, by age and sex, receiving results and 13;
post-test counselling in 2004;
Figure 1: Trends in drug use reflected through new registered cases 10;
in Yangon, Mandalay, Kachin, Shan, Sagaing and Bago;
Figure 2: Number of PLWHA receiving home-based care, 2000-2005;
Figure 3: Actual versus needed ART, 2004 and 2005;
Diagram 1: Illustrative re-structuring of Joint Programme management
and co-ordination structures...
Annex A: Mid-term review itinerary;
Annex B: Joint Programme partner implementing organisations;
Annex C: Pre-review assessment paper topics;
Annex D: Mid-Term review terms of reference;
Annex E: Additional comments received on the first draft mid-term review report..."Myanmar is presently faced with the challenge of controlling a dual epidemic of
Human Immunodeficiency Virus (HIV) and injection drug use. Injection Drug Users
(IDUs) have a very high risk of infection, which can occur soon after an individual
begins injecting. Sexual transmission is another major mode of HIV transmission.
Commercial sex, which is driven by patronage of sex workers by men, is the largest
contributor to this. Transmission is occurring heterosexually outside of the commercial
sex industry and HIV is now in the general population. A substantial amount of sexual
transmission of HIV is also taking place amongst men who have sex with men
(MSM). It is thought that a significant proportion of male youth are at risk because of
having early sex with sex workers. Some migrant populations are at increased risk as
well. The trend of HIV infection amongst women attending antenatal clinics is upward
and it is presumed that HIV is thus being passed on to babies at expected rates.
Acquired Immune Deficiency Syndrome (AIDS) death rates have not been examined,
but rising numbers of orphaned children are being seen and very few programmes to
assist them exist..."

INTRODUCTION:
Clinical stages of HIV/AIDS for adults;
UNHCR point of view on HIV/AIDS;
The right to access to care...
DIAGNOSIS:
Voluntary Counselling and Testing: Are we doing it correctly or p with words?...
MANAGEMENT:
Antiretroviral therapy (ART);
Nutrient requirements for people living with HIV/AIDS;
Mycobacterium Tuberculosis infection in HIV/AIDS...
SOCIAL:
Responding to bad news including HIV/AIDS result; Stigmatization and discrimination;
Home based care: A day as a home visitor and interview;
Testimonial of people living with HIV/AIDS...
PREVENTION:
PMCT activities in Maela refugee camp; How to increase condom use? Cotrimoxazole prophylaxis and Glossary.

Burma’s mushrooming HIV/AIDS problem is already of international concern, but now efforts to keep the lethal disease—and TB and malaria—in check will be further hampered by a Global Fund decision to cut off aid...
"Another storm cloud appears to be heading towards an already battered Burma. But unlike others before it, this is not about such lofty issues as democracy and human rights, or even more down-to-earth issues as forced labor and political prisoners. It involves simply life and death, particularly after the tumultuous decision by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria to cancel its US $98 million program over the next five years.
It is not just a case of saving more people from the clutches of TB and malaria, which already cut a huge swathe of death and misery through the wretched country. Programs to combat these are also now at risk, but it is the potentially more deadly spread of HIV/AIDS which is darkening Burma’s already gloomy horizons..."

Executive Summary:
"A multi-site survey was conducted during September through November 2003 to assess the
knowledge, attitudes and behaviors related to transmission and prevention of HIV and AIDS
among general population and youths residing in seven survey sites in Myanmar. A total of
9678 individuals (4631 males and 5047 females) were interviewed. Of these, 35% were youth
aged 15-24 years. Although 91% of the population had heard about HIV and AIDS, only 35%
knew about methods of HIV prevention and barely 27% were able to correctly reject the
common misconceptions about HIV transmission. Youth, women and respondents with lowest
level of education had the lowest knowledge about HIV prevention. Less than a quarter of the
respondents were willing to buy food from an HIV-infected vendor and just half of them
expressed willingness to care for an HIV-infected relative. Only a quarter of the population
sought treatment for sexually transmitted disease (STD) symptoms; a large proportion of these
consulted a private practitioner or took self treatment and only 15% visited a government
hospital for STD treatment. About 7% of men had sex with a non-regular partner; nearly twothirds
of them had unprotected sex (only 54% of male respondents reported using condom
consistently with a commercial sex worker and 18% with a casual acquaintance). While 68%
respondents expressed the intent for voluntary confidential counseling and testing (VCCT) but
a mere 5% actually got tested and received the result.
The findings of the survey indicate the following programmatic gaps:
* Knowledge about HIV prevention is deficient
* High level of misconceptions about HIV transmission prevail
* Negative attitudes towards PLWHA are common
* Utilization of STD services is suboptimal
* High-risk sexual behaviours exist and unprotected sex is common
* VCCT needs remain unmet..."

Myanmar's HIV/AIDS epidemic -- estimated at 1.2 percent of the population -- is considered one of the most serious in Asia.
But HIV/AIDS is just the latest problem to afflict this chaotic and corrupt country, which produces much of the world's opium and has long suffered from social problems connected to its massive drug smuggling industry, including disease, addiction and organized crime.
In 1988, the Burmese government was overthrown by a corrupt military junta that changed the country's name to Myanmar. Reports of torture and mass murder followed. Western nations withdrew aid and imposed trade sanctions, which have crippled the nation's economy.
* Note: Figures reflect most recent statistics from UNAIDS and the World Health Organization.

Asia Briefing NÃÂ°34;
16 December 2004...
OVERVIEW:
"Myanmar's military government has acknowledged its serious HIV/AIDS problem in the two years since Crisis Group published a briefing paper.[1] This has permitted health professionals, international organisations and donors to begin a coordinated response. The international community has boosted funding and shown more willingness to find ways to help victims and counter the pandemic. Some government obstacles have been removed although the regime's closed nature is unaltered. The opposition National League for Democracy (NLD), which has generally opposed aid involving contact with the junta, has supported many HIV/AIDS steps because of the humanitarian imperative. The urgent need now is to boost the local staff capabilities and make more effective use of the money flowing into the country. In the process civil society and small NGOs and other local organisations can be fostered that can eventually help prepare a democratic transition.
Significant problems remain. About 1.3 per cent of Myanmar's[2] adults are believed to be infected with the virus, one of the highest rates in Asia. Government spending on health and education is perilously low, and the economy has been grossly mismanaged by the military. HIV continues to present serious risks to the population, to security and to Myanmar's neighbours.[3]
Critics of assistance to Myanmar have said the government would misappropriate any funds. This has not been the case so far. Increased international contact with the government on this issue has pushed it towards more pragmatic positions and opened up program possibilities that were not available in 2002. HIV prevention and treatment suffered then from a lack of resources and knowledge. Now the main constraint is the implementation capacity of groups involved in HIV prevention and AIDS care. The critical steps that need to be taken include:
*
expansion of assistance through all available channels to border areas where the HIV problem is particularly intense;
*
expansion of national capacity to deal with HIV, including more technical aid and training;
*
expansion of support for local and community-based organisations to strengthen their capacity and enable them to be larger providers of grassroots education, counselling and treatment;
*
more effective outreach to minority and ethnic communities with HIV/AIDS prevention education as well as counselling and treatment;
*
streamlining of disbursement, evaluation and monitoring procedures for funding; and
*
expansion of harm reduction programs.
The political situation in Myanmar is extremely uncertain. Former Prime Minister Khin Nyunt is now under arrest on suspicion of corruption. He had chaired a key government committee on health issues and had supported greater involvement of international NGOs in fighting HIV. It is now very unclear whether further steps forward will be possible."... You might have to register (free) to access the document.

"The purpose of the Joint Programme for HIV/AIDS: Myanmar, 2003-2005, is to strengthen the enabling
environment and supporting capacity for prevention and care of HIV/AIDS in Myanmar. This will be done in support of the National Strategic Plan for the expansion and upgrading of HIV/AIDS activities in Myanmar
2001-2005, of the National Health Plan and of the operational plans of implementing partners for this
period. The success of this programme will build towards the establishment of an effective multisectoral
response to the HIV/AIDS epidemic and in the longer term the mitigation of the health and socioeconomic
impact on the people of Myanmar..."
CHAPTER 1 Programme Background and Rationale: 1.1 HIV/AIDS Epidemic in Myanmar; 1.2 Programme Approach;
1.3 Implementing Partners...
CHAPTER 2 Joint Programme Objectives (The Logical Framework)...
CHAPTER 3 Component Strategies of the Joint Programme:
3.1 Sexual Transmission of HIV;
3.2 Injecting Drug Use;
3.3 Knowledge and Attitudes;
3.4 Care, Treatment and Support for People Living with HIV/AIDS;
3.5 Enabling Environment...
CHAPTER 4 Implementation Arrangements:
4.1 Management and Coordination Arrangements;
4.2 Establishing the Monitoring and Evaluation Framework;
CHAPTER 5 Financing the Joint Programme...
ANNEXES:
Annex 1 United Nations Expanded Theme Group on HIV/AIDS:
Purpose and Terms of Reference;
Annex 2 Technical Working Group on HIV/AIDS:
Purpose and Terms of Reference;
Annex 3 UNAIDS Secretariat: Purpose and Scope of Work
in Relation to the Joint Programme...
Annex 4 Proposed Joint Programme Monitoring and Evaluation Framework
(Core Indicator Set)... Annex 5 Monitoring Schedule for the Joint Programme...
Annex 6 Fund for HIV/AIDS in Myanmar (FHAM)...
Annex 7 References.

I. Executive Summary;
II. Introduction;
III. Thailand: Background.
IV. Burma: Background.
V. Project Methodology;
VI. Findings:
Hill Tribe Women and Girls in Thailand; Burmese Migrant Women and Girls in Thailand;
VII. Law and Policy â“ Thailand;
VIII. Applicable International Human Rights Law;
IX. Law and Policy â“ United States
X. Conclusion and Expanded Recommendations..."This study was designed to provide critical insight and
remedial recommendations on the manner in which
human rights violations committed against Burmese
migrant and hill tribe women and girls in Thailand render
them vulnerable to trafficking,2 unsafe migration,
exploitative labor, and sexual exploitation and, consequently,
through these additional violations, to
HIV/AIDS. This report describes the policy failures of
the government of Thailand, despite a program widely
hailed as a model of HIV prevention for the region.
Physicians for Human Rights (PHR) findings show that
the Thai government's abdication of responsibility for
uncorrupted and nondiscriminatory law enforcement
and human rights protection has permitted ongoing violations
of human rights, including those by authorities
themselves, which have caused great harm to Burmese
and hill tribe women and girls..."

"Chris Beyrer has worked on HIV/AIDS issues along the Thai-Burma border since the early 1990s and is now associate research professor and director of the Johns Hopkins University Fogarty AIDS International Training and Research Program. He spoke with Irrawaddy reporter Naw Seng about efforts in Burma to control the epidemic..."

Assessment of the epidemiological situation 2004
The national adult prevalence of HIV infection is between 1% to 2%. Myanmar is thus characterized as having a "generalized" epidemic. However, the spread of the HIV infection
across the country is heterogenous varying widely by geographical location and by population sub group.
HIV was introduced in Myanmar in mid-to-late 1980s and by the end of 2003, a cumulative 7,174 AIDS cases and 3,324 AIDS deaths have been reported. The male-to-female ratio
among reported cases is 3.6:1. Among cases with known mode of transmission, 65% acquired infection by heterosexual route, 26% by injecting drug use, and 5% by contaminated
blood.

"HLAING THAYAR, MYANMAR (BURMA)--Myanmar has one of the worst HIV problems in Asia, fueled by a potent mix of injecting drug use and commercial sex work. Yet poverty and the country's military dictatorship pose formidable obstacles to doing battle against AIDS here. This story is part of a series on HIV/AIDS in Asia; the stories in this initial installment focus on Myanmar, Vietnam, Cambodia, and Thailand..."

"Burma has taken the first step to tackling its deepening AIDS epidemic: admitting the problem exists. But it has a long way to go to bring the problem under control...
As Burma's HIV/AIDS epidemic mounts, researchers at Johns Hopkins University say an adequate response is going to entail not just pumped up resources, but also "political will" on the part of the government. The AIDS specialist notes that one recent development gives cause for hope. "There is a good Minister of Health [Dr Kyaw Myint] now," he says. "He seems to have a heart and he's interested in healthï¿½.that's a change..."

"The Irrawaddy spoke to Dr Myat Htoo Razak about the severity of the HIV/AIDS situation in Burma. He is a medical doctor and PhD from Burma who specializes in Epidemiology of Infectious Diseases with an emphasis on HIV/AIDS and Health Policy and Planning. He currently works in HIV/AIDS research, prevention, care, and support programs in Asia through various international agencies and institutions...
Question: How serious is the HIV/AIDS situation in Burma?Answer: As a health worker and a person from Burma, I would say the HIV/AIDS situation is one of the country's most serious health and social challenges since the late 1980s. The focus has mainly been on how many are infected, as estimated numbers of people with HIV/AIDS in Burma vary. The UNAIDS 2002 report estimated from 180,000 to 420,000 cases, while another group of researchers estimated 687,000 cases. It doesn't matter whether the number is one hundred or one million if little is being done to prevent more infections and to provide care and support to those who are already infected. We need to have good estimates for better planning but Burma needs to move forward with action now. I deeply hope that people in Burma will soon be able to respond effectively to this serious health, social and development challenge..."

The HIV/AIDS crisis, UK assistance and the general political situation.
"The Irrawaddy interviewed Vicky Bowman, the British Ambassador to Burma. She previously worked in the British Embassy in Rangoon from 1990 to 1993 before returning in Dec 2002. The UK recently announced that it would contribute 10 million pounds (US $15.7 million) over the next three years to combat the spread of HIV/AIDS in Burma...
Question: Why did the British government decide to take action now?
Answer: We've been providing some support to NGOs to combat HIV for several years, for example for subsidized condoms. But we believe that the time has now come to increase our support, both because the scale of the problem is such that it needs a significant response, and because the climate for working on HIV/AIDS in Burma is gradually improving.
Q: Do you think the Burmese military has realized the seriousness of the AIDS epidemic?..."

"HIV prevalence is rising rapidly in Burma/Myanmar, fuelled by population
mobility, poverty and frustration that breeds risky sexual activity and
drug-taking. Already, one in 50 adults are estimated to be infected, and
infection rates in sub-populations with especially risky behaviour (such as
drug users and sex workers) are among the highest in Asia. Because of the
long lag time between HIV infection and death, the true impact of the
epidemic is just beginning to be felt. Households are losing breadwinners,
children are losing parents, and some of the hardest-hit communities,
particularly some fishing villages with very high losses from HIV/AIDS, are
losing hope. Worse is to come, but how much worse depends on the
decisions that Myanmar and the international community take in the coming
months and years... Myanmar stands perilously close to an
unstoppable epidemic. However large scale action targeted at helping those
most at risk protect themselves could still make a real difference. Action on
the scale necessary will inevitably involve working through government
institutions, possibly in partnership with NGOs. The international community,
and bilateral donors in particular, should look for ways to channel resources
to Myanmar in ways that encourage political commitment and capitalise on
the emerging willingness to confront the HIV epidemic..."

Myanmar is considered to have one of the most severe HIV epidemics in Asia due to the high prevalence of injecting drug use and HIV among drug users. Reports suggest there are approximately 150,000 to 250,000 IDUs in Myanmar. In 1997 HIV prevalence among IDUs was 54%, in 2000 this had risen to 63% and in some states was among the highest rate in the world, at up to 96%. National surveillance data shows that IDUs in Myanmar often become infected with HIV early in their injecting careers which is rarely seen elsewhere in the world.
Date of release 8 February 2002
Author:
Publisher:
(Extract on Myanmar, pp 140-150

"More than a million miners desperately excavate the bedrock of a remote valley hidden in the shadows of the Himalayas. They are in search of just one thing - jadeite, the most valuable gemstone in the world. But with wages paid in pure heroin and HIV rampant, the miners are paying an even higher price. Adrian Levy and Cathy Scott-Clark travel to the death camps of Burma...Hpakant is Burma's black heart, drawing hundreds of thousands of people in with false hopes and pumping them out again, infected and broken. Thousands never leave the mines, but those who make it back to their communities take with them their addiction and a disease provincial doctors are not equipped to diagnose or treat. The UN and WHO have now declared the pits a disaster zone, but the military regime still refuses to let any international aid in..." jade

"HIV has been well established in Asia for many years. However, many countries have recorded relatively low rates of infection even in sub-populations with high-risk behaviour. At the time of the last MAP report on Asia from Kuala Lumpur in 1999, only Thailand, Myanmar, and Cambodia were reporting substantial nation wide epidemics, with a number of states in India and provinces in China also heavily affected. In the last two years, the picture has changed dramatically. Indonesia, Iran, Japan, Nepal and Vietnam, for example, have all registered marked increases in HIV infection in recent years, while in China, home to a fifth of the world's people, the infection seems to be moving into new groups of the population..."

"Release from prison is no guarantee of freedom in Burma, where the ruling junta’s control over the
lives of political prisoners often extends as far as their graves.
On June 12 and July 12 this year, two people passed away from AIDS-related diseases in Burma. Exactly one
month after Bo Ni Aung died on June 12, 2001, Si Thu, also known as Ye Naing, succumbed to that incurable
syndrome. These days, in fact, it seems to be nothing unusual or surprising when we hear about more
victims of HIV/AIDS. Yet the true story shows that these two were not so much victims of AIDS, but of
Burma’s ruling junta, which calls itself the State Peace and Development Council (SPDC).
Both of them died as a result of the junta’s inhumane treatment of prisoners. Bo Ni Aung, 42, had been a
political prisoner who was set free in the middle of 1999, having spent more than eight years in two
disreputable prisons, Insein and Thayet. Si Thu died while being detained under Article 10(a) of the State
Protection Act in Tharawaddy prison. Aged 35, he was a former student activist who had been incarcerated
for 11 years in Insein and Tharawaddy, not far from the Burmese capital..."

HIV/AIDS infection has reached epidemic proportions in Burma today and reports by UN agencies as well as independent health professionals unanimously confirm this fact. Estimates suggest at least five percent of the population is infected. The alarming situation has become a national emergency that affects all groups, including non-Burman ethnic nationalities and the military. . . .

"The SPDC has finally acknowledged the AIDS epidemic in Burma. But even now, the junta spends more of the country’s dwindling resources on attacking democrats than it does on tackling the disease, Aung Zaw writes..."

Fighting "Fire" vs. Preventing "Fire". Preventing HIV/AIDS and fighting it are both very challenging. It will take courage, expertise, commitment and support to destroy the deadly virus, writes Dr Saw Lwin.

Review of "Out of Control 2"..."...A new report, titled “Out Of Control 2”, issued by the Southeast Asian Information Network [SAIN] shows the involvement of Burmese regime officials in narcotics trafficking and the correlation of increased drug trade and rising HIV/AIDS rates in Burma and beyond its borders..."

Dancing alone o­n the floor of a popular Rangoon nightclub in front of a huge video screen playing music videos, the young Burmese woman repeatedly glances at the very few western men in the disco. She approaches them and makes it clear her charms come at a price. Does she use condoms?

A new report, titled “Out Of Control 2”, issued by the Southeast Asian Information Network [SAIN] shows the involvement of Burmese regime officials in narcotics trafficking and the correlation of increased drug trade and rising HIV/AIDS rates in Burma and beyond its borders.
The report states that the last several years have produced a mounting body of evidence indicating high-level involvement of some junta members in the illicit narcotics industry. Routes and methods of transportation and export of Burmese narcotics are described in this report.

As if life in Burma was not grim enough, with its poverty and its brutal government, it now turns out to have an AIDS epidemic. Thousands of young adults have died without ever having heard of the disease that killed them, let alone of ways to prevent it. In parts of Burma, funerals of people in their 20s or 30s are an everyday occurrence.

A former political prisoner recalls the tale of HIV horror inside the notorious Insein prison. Slorc used to threaten political prisoners with the cancellation of visiting rights, beating, transferal to another prison or an unfamiliar cell-block, solitary confinement and extension of prison-terms. But it was not successful. Now, they use more effective weapons to threaten prisoners.

Abstract
Over 50 years ago, the Constitution of WHO projected a vision of health as a state
of physical, mental and social well-being - a definition that has important conceptual and
practical implications. Recently, health professionals begin to recognize the importance
of the protection and promotion of human rights as necessary precondition for individual
and community health. It is now clear that regardless of the effectiveness of technologies,
the underlying civil, cultural, economic, political and social conditions have to be
addressed as well in the health care paradigm.

"Welcome to AIDScience. As of 31 December 2003, AIDScience ran out of operating funds. The Web site is now archived.
"The American Association for the Advancement of Science (AAAS), publisher of Science magazine, launched this Web site to provide researchers with a premier, centralized and global online source of information on all aspects of AIDS prevention and vaccine development..." ... "As of 31 December 2003, AIDScience ran out of operating funds. The Web site is now archived."

"The guide provides comprehensive information on HIV/AIDS mainstreaming and assists project staff to identify ways to effectively address the root causes of HIV infection and to mitigate the effects of HIV and AIDS on their core activities. It also addresses HIV and AIDS issues concerning staff within an organization.
The guide was developed and revised in conjunction with Misereor partners in the South. Many of the examples and explanations were taken from African contexts; nevertheless the guide is designed to be used also in Asian and Latin American countries. Therefore you will also find references to non-African countries in this guide.
Contents:
* Responding to HIV and AIDS: HIV and AIDS as a development issue and introduction to the mainstreaming concept...
* Root causes of HIV infection and effects of HIV and AIDS...
* Mainstreaming: A practical guide...
* Good practice examples of HIV/AIDS mainstreaming...
*Seeking pathways within and beyond your organisation..."

Foreword:
"HIV and AIDS have various implications on the life of individuals, families, communities
and societies. HIV and AIDS are not “merely” a health but also a development issue
as they reduce chances for development and increase poverty. People living with HIV,
households headed by women, elderly or orphans often have barriers to perform
like others not affected by HIV and AIDS. Therefore they need specific attention and
tailor-made responses in the different development sectors focusing on their needs,
abilities and skills.
One of the main pillars of Misereor’s work and its partners’ in different countries
in Africa, Asia and Latin America is the reduction of poverty and assistance of the
poor and the marginalized. Misereor and its partners have to take HIV and AIDS into
account in development projects.
This document was conducted as a desk study for the revision of the Misereor guide
“Responding to HIV and AIDS – A practitioner’s guide to mainstreaming in development
projects” (published 2010). It provides useful information and practical examples of
such responses in the fields of agriculture, rural development, self-help and social
protection. It aims to invite Misereor partners and others working in these fields to
reflect on their current approaches and to encourage them to respond in their core
business to the challenges brought by HIV and AIDS."

Background: There has been tremendous scale-up of antiretroviral therapy (ART)
services in the Asia Pacific region, which is home to an estimated 4.7 million persons
living with HIV/AIDS. We examined treatment scale-up, ART program practices, and
clinical outcome data in the nine low-and-middle-income countries that share over
95% of the HIV burden in the region.
Methods: Standardized indicators for ART scale-up and treatment outcomes were
examined for Cambodia, China, India, Indonesia, Myanmar, Nepal, Papua New
Guinea, Thailand, and Vietnam using data submitted by each country to the WHO/
The Joint United Nations Programme on HIV/AIDS (UNAIDS)/UNICEF joint framework
tool for monitoring the health sector response to HIV/AIDS. Data on ART program
practices were abstracted from National HIV Treatment Guidelines for each country.
Results: At the end of 2009, over 700 000 HIV-infected persons were receiving ART in
the nine focus countries. Treatment coverage varies widely in the region, ranging from
16 to 93%. All nine countries employ a public health approach to ART services and
provide a standardized first-line nonnucleoside reverse transcriptase inhibitor-based
regimen. Among patients initiated on first-line ART in these countries, 65–88% remain
alive and on treatment 12 months later. Over 50% of mortality occurs in the first
6 months of therapy, and losses to follow-up range from 8 to 16% at 2 years.
Conclusion: Impressive ART scale-up efforts in the region have resulted in significant
improvements in survival among persons receiving therapy. Continued funding support
and political commitment will be essential for further expansion of public sector ART
services to those in need. To improve treatment outcomes, national programs should
focus on earlier identification of persons requiring ART, decentralization of ART
services, and the development of stronger healthcare systems to support the provision
of a continuum of HIV care....Keywords: antiretroviral therapy, Asia Pacific, HIV, outcomes, scale-up,
treatment

"Thailand has experienced some degree of success in preventing uncontrolled spread of
HIV, and in providing effective care for persons living with HIV/AIDS (PLHA).
Nevertheless, HIV transmission is still occurring, especially among those less fortunate
who migrate to seek economic opportunity. A prime example of this are the lower-income
populations of some of Thailand’s neighbors who come to work on fishing boats or in the
fishery industry of Thailand. The vulnerability of these populations comes from their
relative lack of knowledge and understanding of HIV prevention and tendency to engage
in higher risk sexual behavior than when in their home communities of origin.
To address these vulnerabilities, the Prevention of HIV/AIDS among Migrant Workers in
Thailand Project (PHAMIT) was conceived and implemented by the Raks Thai
Foundation in collaboration with six NGO partners including: Empower Foundation, the
Foundation for AIDS Rights (FAR), World Vision Foundation/Thailand, the Stella Maris
Seafarers Center, the MAP Foundation, and the Pattanarak Foundation. Funding for the
Project was provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria
(GFATM) with the goal to lower the incidence of HIV among foreign migrant workers in
Thailand through communication strategies to reduce risk behaviors and support access
from migrants to general health and reproductive health services. The Project was
implemented during 2003-2008.
In order to independently assess the performance of the PHAMIT Project compared to its
targets and objectives, the Raks Thai Foundation contracted with the Institute for Population
and Social Research (IPSR) of Mahidol University to conduct a final Project evaluation in
2008.
IPSR would like to express its gratitude to Mr. Promboon Panitchapakdi, Executive
Director of the Raks Thai Foundation for entrusting this important evaluation to the
researchers of IPSR. It is our hope that the findings of this evaluation will be of benefit to
the Project implementers, the PHAMIT partners in the field who will continue to deliver the
interventions, and to any persons interested in conducting evaluation research of this type."

This Material is an adaptation of “The Testing and Counseling for Prevention of Mother-to-Child Transmission of HIV (TC for PMTCT) Support
Tools” initially developed by the United States Department of Health and Human Services, Centers for Disease Control and Prevention
(HHS-CDC), Global AIDS Program (GAP), in collaboration with the Department of HIV/AIDS at the World Health Organization (WHO),
the United Nations Children’s Fund (UNICEF), and the United States Agency for International Development (USAID).
This material combines “Antenatal Pre-Test Session Flipchart” and “Antenatal Post-Test Session Flipchart” into one single original document,
available in Burmese as well as in Karen language.
This Flipchart was especially designed and developed to fit the geographical, ethnic and social context of Thai-Burmese border’s refugee
camps.
This adaptation was made under the supervision of AMI (Aide Médicale Internationale) in Mae Sot, Thailand.

This Material is an adaptation of “The Testing and Counseling for Prevention of Mother-to-Child Transmission of HIV (TC for PMTCT) Support
Tools” initially developed by the United States Department of Health and Human Services, Centers for Disease Control and Prevention
(HHS-CDC), Global AIDS Program (GAP), in collaboration with the Department of HIV/AIDS at the World Health Organization (WHO),
the United Nations Children’s Fund (UNICEF), and the United States Agency for International Development (USAID).
This material combines “Antenatal Pre-Test Session Flipchart” and “Antenatal Post-Test Session Flipchart” into one single original document,
available in Burmese as well as in Karen language.
This Flipchart was especially designed and developed to fit the geographical, ethnic and social context of Thai-Burmese border’s refugee
camps.
This adaptation was made under the supervision of AMI (Aide Médicale Internationale) in Mae Sot, Thailand.

Conclusion: "Boatmen in Teknaf are an integral part of a high-risk sexual behaviour
network between Myanmar and Bangladesh. They are at risk of obtaining HIV infection
due to cross border mobility and unsafe sexual practices. There is an urgent need for
designing interventions targeting boatmen in Teknaf to combat an impending epidemic of
HIV among this group. They could be included in the serological surveillance as a
vulnerable group. Interventions need to address issues on both sides of the border, other
vulnerable groups, and refugees. Strong political will and cross border collaboration is
mandatory for such interventions."

I. Executive Summary;
II. Introduction;
III. Thailand: Background.
IV. Burma: Background.
V. Project Methodology;
VI. Findings:
Hill Tribe Women and Girls in Thailand; Burmese Migrant Women and Girls in Thailand;
VII. Law and Policy â“ Thailand;
VIII. Applicable International Human Rights Law;
IX. Law and Policy â“ United States
X. Conclusion and Expanded Recommendations..."This study was designed to provide critical insight and
remedial recommendations on the manner in which
human rights violations committed against Burmese
migrant and hill tribe women and girls in Thailand render
them vulnerable to trafficking,2 unsafe migration,
exploitative labor, and sexual exploitation and, consequently,
through these additional violations, to
HIV/AIDS. This report describes the policy failures of
the government of Thailand, despite a program widely
hailed as a model of HIV prevention for the region.
Physicians for Human Rights (PHR) findings show that
the Thai government's abdication of responsibility for
uncorrupted and nondiscriminatory law enforcement
and human rights protection has permitted ongoing violations
of human rights, including those by authorities
themselves, which have caused great harm to Burmese
and hill tribe women and girls..."

"HIV has been well established in Asia for many years. However, many countries have recorded relatively low rates of infection even in sub-populations with high-risk behaviour. At the time of the last MAP report on Asia from Kuala Lumpur in 1999, only Thailand, Myanmar, and Cambodia were reporting substantial nation wide epidemics, with a number of states in India and provinces in China also heavily affected. In the last two years, the picture has changed dramatically. Indonesia, Iran, Japan, Nepal and Vietnam, for example, have all registered marked increases in HIV infection in recent years, while in China, home to a fifth of the world's people, the infection seems to be moving into new groups of the population..."

Abstract:
"Hepatitis B virus (HBV) infection is considered an important health problem in Myanmar as surveys carried out among different population groups revealed HBsAg carrier rate of 10-12%. Health authorities have taken various steps to reduce the incidence of hepatitis B and hepatitis B-associated chronic liver disease in Myanmar. In that context, interruption of its route of transmission and immunization of the susceptible host are the two main approaches. Research studies indicate that the vertical route of transmission might be the commonest route in Myanmar, although the possibility of horizontal transmission through sharing of razors and toothbrushes, or local customs leading to iatrogenic transmission of HBV infection could exist. In view of that, public education on transmission of HBV and means of interrupting it should be carried out especially focusing on specific high-risk groups. Moreover, to interrupt mother-to-infant transmission of HBV infection, hepatitis B vaccination should be promoted. As Expanded Programme of Immunization (EPI) is a successful public health measure in Myanmar, incorporation of hepatitis B vaccine into the EPI programme will eventually lead to the control of hepatitis B infection in Myanmar."

Abstract: We carried out a molecular characteristic-based epidemiological survey of various hepatitis
viruses, including hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis E virus (HEV), and
GB virus C (GBV-C)/hepatitis G virus (HGV), in Myanmar. The study population of 403 subjects
consisted of 213 healthy individuals residing in the city of Yangon, Myanmar, and the surrounding
suburbs and 190 liver disease patients (155 virus-related liver disease patients and 35 nonviral
disease patients). The infection rates of the viruses among the 213 healthy subjects were as follows: 8% for HBV (16 patients),
2% for HCV (4 patients), and 8% for GBV-C/HGV (17 patients). In contrast, for 155 patients with acute hepatitis, chronic
hepatitis, liver cirrhosis, or hepatocellular carcinoma, the infection rates were 30% for HBV (46 patients), 27% for HCV
(41 patients), and 11% for GBV-C/HGV (17 patients). In the nonviral liver disease group of 35 patients with alcoholic liver
disease, fatty liver, liver abscess, and biliary disease, the infection rates were 6% for HBV (2 patients), 20% for HCV
(7 patients), and 26% for GBV-C/HGV (9 patients). The most common viral genotypes were type C of HBV (77%), type 3b
of HCV (67%), and type 2 of GBV-C/HGV (67%). Moreover, testing for HEV among 371 subjects resulted in the detection
of anti-HEV immunoglobulin G (IgG) in 117 patients (32%). The age prevalence of anti-HEV IgG was 3% for patients younger
than 20 years and 30% or more for patients 20 years of age or older. Furthermore, a high prevalence of anti-HEV IgG (24%)
was also found in swine living together with humans in Yangon. These results suggest that these hepatitis virus infections are
widespread in Myanmar and have led to a high incidence of acute and chronic liver disease patients in the region.
and Kenji Abe1,*

“PEOPLE are afraid of us; when I go into town they give me a dirty look,” says U Mg Mg Khin, 73, a leprosy patient at the Mayanchaung Welfare Centre, Halegu township, in Yangon Division. “I have to hide my hands and legs whenever I go into town.”
The centre, which is about 80 kilometres (50 miles) from Yangon and located close to the Yangon-Naypyitaw highway, operates under the Department of Social Welfare and currently houses 56 former leprosy patients.

eprosy has been a major public health problem in
Myanmar for many years. By the 1950s, Myanmar
ranked as a country with one of the highest
prevalence rates of the disease. The Government of Union
of Myanmar had been fighting against the disease with
the expertise and advice of the World Health Organization
(WHO) and INGOs. WHO has closely supported the leprosy
programme in Myanmar from the 1960s through several
projects, as well as research to develop better preventive
and curative methods against leprosy.
WHO MDT was introduced in Myanmar in 1986. The
leprosy prevalence at that time was 59.3 per 10,000
population with 222,209 registered leprosy cases in the
country. Nationwide MDT Programme started in hyperendemic
areas in 1988. The prevalence rate was 39.9 per
10,000 with 155,857 registered cases.

THE JAPAN International Cooperation Agency (JICA) has already spent 300 million Yen (K275 million) in its five-year pilot project in leprosy control and rehabilitation in Myanmar, a senior official with JICA said last week.
“JICA implemented a pilot plan in April 2000 which will run until March 2005. So far we have spent about 100 million Yen (Kyats 915m) annually,” said Dr Yutaka Ishida, Chief Adviser, Leprosy Control and Basic Health Services.
The JICA project covers 48 townships in Mandalay, Magwe and Sagaing divisions including the Special Skin Hospital and a leprosy community in Hlegu Township in Yangon Division.

Leprosy patients are humans with eyes seeing others smiling and laughing, with ears hearing jokes and laughter, and with faces that could smile and laugh, but who never laugh or smile once they have acquired the disease. Now with multi-drug therapy, they are smiling and laughing like others.
Excerpts from “Thitsar Yaysin [Holy Truths]" by Chit San Win#
* Introduction
Leprosy is a disease recognized globally as a dreadful illness associated with the great social, mental, and physical suffering. In ancient days, people knew leprosy as “Kushtha” as it was termed in Sanskrit. The disease is supposed to be originated in India and spread around the world over 2 500 years ago.

Leprosy has been endemic in Myanmar since
ancient times. The earliest information on the
prevalence of leprosy in Myanmar came from a
report by the Leprosy Commission in India
published in 1893. During the census in 1891,
6464 cases or 8.4 per 10000 population were
recorded in a population of 7.5 million. But the
illness was diagnosed by enumerators without the
knowledge of leprosy.
Several surveys have been carried out
since 1932 (Tha Saing-Santra) which indicated
high prevalence in various parts of the country

SUMMARY — Seventy-one Burmese adult patients with lepromatous leprosy were
treated with various regimens of rifampicin monotherapy, 450 mg. daily for 60
days or 900 mg. once weekly for 12 weeks or 450 mg. daily for six months. Of the
patients, 18 had relapsed after stopping DDS therapy, 20 were intolerant of DDS, 18
were DDS resistant and 15 had received no previous treatment.
Rifampicin produced a 75% reduction in the size of skin nodules in two thirds
of the patients and a complete disappearance of nodules in the others. After one month
drug treatment the MI fell to zero but the BI remained unchanged. The once weekly
regimen was as effective as the daily treatment. Four patients had to be withdrawn
due to ENL reactions.
NOTE:The contents of this paper were presented at the Burma Medical Conference, 1977.

"Elephantiasis (Greek ελεφαντίασις, from ελέφαντας, "the elphant") is a syndrome that is characterized by the thickening of the skin and underlying tissues, especially in the legs and genitals. Elephantiasis generally results from obstructions of the lymphatic vessels. It is most commonly caused by a parasitic disease known as lymphatic filariasis..."

How Burma’s dams project could spread disease...
"When Nang A Cha, a Shan migrant, consulted a doctor in Chiang Mai, northern Thailand, complaining of a fever and a swollen leg, the physician initially suspected malaria. A blood test ruled that out, but the young laboratory technician was still puzzled by what he saw under the microscope and sent the blood smear to his supervisor, a semi-retired man who had been trained in parasitology about 40 years previously.
He was astounded by what he saw: for the first time in 30 years, he gazed at an old nemesis, an entity believed eradicated from urban Thailand. There was no mistaking the threadlike shadows in the blood smear: Wuchereria bancrofti, the parasite responsible for lymphatic filariasis, more colloquially known as elephantiasis, a term conjuring up images of grotesquely swollen limbs and severe disability.
Lymphatic filariasis is transmitted by the bite of an infected mosquito. Once inside the human host, the parasite resides in the lymphatic system, producing larvae which then migrate back to the blood and are subsequently picked up by mosquitoes to continue the infection cycle. Over time, progressive damage to the lymphatics causes obstructions and subsequent swelling from accumulation of lymph..."

"In addition to recording the second most malaria deaths of any country in Southeast Asia, Myanmar is a regional epicenter of spreading resistance to vital anti-malarial drugs. The situation is worst in ethnic areas in the eastern, western and northern border regions, which receive little or no government health services and are inaccessible to large-scale international efforts. These regions are populated with displaced and vulnerable communities and rife with fake anti-malaria drugs, contributing to a growing reservoir of infection and a “perfect storm” of conditions to encourage increasing resistance to key artemisinin-based drugs.
With in-depth mentoring and technical support from CPI, our local partners have conducted the only peer-reviewed surveys in this inaccessible region, demonstrating that malaria accounts for nearly half of all deaths, with a disproportionate impact on children and pregnant women: Nearly 15% of children will die before their fifth birthday, one-third from malaria, and malaria is the leading cause of maternal anemia, stillbirth, premature birth and low birth weight....
For malaria-related articles and reports, see links at right"

Burma records the most malaria deaths of any country in Southeast Asia, but preventive and curative services remain unavailable to the most vulnerable populations living in ethnic areas along the borders of India, China and Thailand.
Since 2001 Planet Care/GHAP has increased the capacity of local ethnic health organizations to increase access for villagers to proven preventive and curative malaria interventions. Beginning with a modest pilot program among 1,800 Karen internally displaced peoples (IDPs) in four villages along the Thai-Burma border, effective malaria interventions now reach 60,000 villagers in about 140 villages along three of Burma's borders.
The details of the program along each border, described below, are modified according to local guidelines, but are based on over four years of experience reducing malaria transmission along the Thai border.

"Malaria is one of the major public health problems with around 40.6 million people at risk. Although much of the population is at risk of malaria, the most vulnerable are non-immune migrant workers occupied with gem-mining in forests, logging, agriculture and construction. Annually, around 200,000 confirmed malaria cases and around 1200 malaria deaths are recorded every year. The Pf percentage of reported malaria cases are more than 75%. Malaria transmission in the country is perennial. About 60% of the total malaria cases are reported from forest areas. ITNs / LLINs are used as a main tool for vector control. IRS has been applied selectively to control epidemics only. For case detection in the areas not covered by microscopy, the Rapid Diagnostic Test (RDT) is used. Around 40% of the malaria cases are seeking treatment through the private sector...Myanmar has reported an increase in the number of confirmed malaria cases from 120,029 in 2000 to 447,073 in 2008 and 414,008 in 2009 respectively (Fig.1). This increase in reported confirmed cases was mainly due to increase in the case finding activities (including use of RDT). As a result reported number of probable malaria cases are decreasing. The percentage of P. falciparum cases has increased from 80% in 2000 to 97% in 2008 and 91% in 2009 (as almost all RDTs are used to detect Pf cases only). The number of malaria admissions and malaria attributed deaths declined from 85,409 and 2752 respectively in 2000 to 47,772 and 972 respectively in 2009. Amongst inpatient admissions, the proportion of malaria cases declined from 16% in 2000 to 6-7% and of all admissions in 2008-09. These statistics suggest that there is some improvement in the malaria situation in the country. However, the reasons behind these trends, such as improved diagnostic practices or the effect of increased use of ACTs (Fig2), are not clear. Between 2007 and 2009 2.28 million ITNs were delivered(Fig3)..."

SMRU was established in 1986 in Shoklo. It is a field station of the faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, and is part of the Mahidol-Oxford Research Unit (MORU) supported by the Wellcome Trust (UK)... Location:
The S.M.R.U base is in Mae Sot and the activities extend to the populations living along the Thai-Myanmar border...
Beneficiaries:
Population living along the border, including refugees and other migrants...
Objectives:
1. To treat and care for patients with malaria....
2. To define the epidemiology, entomology, and clinical features of malaria in this area of low (unstable) transmission, and to determine the best methods of prevention and treatment...
3. To advise the Thai Medical Institutions and the Non Governmental Organisations involved in the treatment and the control of malaria in the South East Asia region.
Project Objectives:
The projects are designed to be of direct benefit to the local community, and also to provide information useful to other populations living in malaria endemic areas elsewhere in the world through publications in mainstream international scientific journals...
Project Areas:
1. Malaria in Pregnancy and Infancy;
2. Malaria treatment studies;
3. Entomology;
4. HIV/Aids awareness and prevention of vertical transmission;
5. Nutrition and Anaemia;
6. Laboratory studies;
7. Control of malaria and detection of epidemics along the border..." ...Very useful site with news, abstracts of publications -- not full text, unfortunately)-- Substantial "Laboratory Manual for Laboratory Technician Training" and other training documents in Burmese and English..."

The World Health Organization said Thursday that governments in the Mekong region must act “urgently” to stop the spread of drug-resistant malaria which has emerged in parts of Vietnam and Myanmar.
There is growing evidence that the malaria parasite is becoming resistant to a frontline treatment, the anti-malarial drug artemisinin, in southern and central Vietnam and in southeastern Myanmar, the WHO said in a statement.

"New research shows that artemisinin-resistant malaria has emerged and increased rapidly along the Thailand-Myanmar border, with implications for the regions containment strategy" - "The Lancet"....For the full text of "The Lancet" article, go to http://www.thelancet.com and search for Artemisinin-resistant malaria - you will need to register to read it - free...The other article, in "Science" of 6 April can be accessed at http://www.sciencemag.org -- similar search, but you have to pay to register.

Language:

English

Source/publisher:

AFP via "Bangkok Post" from "The Lancet" 5 April and "Science" 6 April

"A drug-resistant strain of the disease malaria - first detected about 18 months ago near the Thailand-Cambodia border - is now showing up again along Thailand's border with Myanmar.
Many patients in the region taking anti-malarial drugs are now taking much longer to respond to treatment.
Medics fear the resistant strain could eventually spread to Africa, where most of the world's malaria cases and deaths occur.
Aela Callan reports from a clinic near the Thai town of Mae Sot on the border with Myanmar."

"Approaches to expand malaria control interventions in areas of active conflict are
urgently needed. Despite international agreement regarding the imperative to
control malaria in eastern Burma, there are currently no large-scale international
malaria programmes operating in areas of active conflict. A local ethnic health
department demonstrated that village health workers are capable of implementing
malaria control interventions among internally displaced persons (IDPs). This
paper describes how these internally displaced villagers facilitated rapid expansion
of the programme.
Clinic health workers received training in malaria diagnosis and treatment,
vector control and education at training sites along the border. After returning to
programme areas inside Burma, they trained villagers to perform an increasingly
comprehensive set of interventions. This iterative training strategy to increase
human resources for health permitted the programme to expand from 3000 IDPs
in 2003 to nearly 40,000 in 2008.
It was concluded that IDPs are capable of delivering essential malaria control
interventions in areas of active conflict in eastern Burma. In addition, health
workers in this area have the capacity to train community members to take on
implementation of such interventions. This iterative strategy may provide a model
to improve access to care in this population and in other conflict settings..."
Keywords: internally displaced persons; village health workers; human rights;
human resources for health; malaria control

JAPAN International Cooperation is leading the fight against three major diseases in Myanmar. The Myanmar Times’ Khin Myat met with JICA project leader and tuberculosis specialist, Mr Kosuke Okada, and malaria expert Mr Masatoshi Nakamura to ask about their activities.
1. How much money is JICA spending annually to control these diseases?
Our project period is from January 2005 to January 2010. We have been spending around ¥150 million per year on long- and short-term experts, international and domestic training, provision of equipment such as vehicles, lab equipment, microscopes, mosquito nets, lab test kits, local training and consumables.

"The 15th Edition of SMRU Malaria handout:
English and Burmese Edition (November 2007) prepared for the NGOs working along the Thai-Burma border and other groups confronting malaria in the region. It is composed of short summaries on treatment of uncomplicated malaria and of uncomplicated hyperparasitaemia, treatment of severe malaria and malaria in pregnancy."

Abstract:
:Background: Burma records the highest number of malaria deaths in southeast Asia and may
represent a reservoir of infection for its neighbors, but the burden of disease and magnitude of
transmission among border populations of Burma remains unknown.
Methods: Plasmodium falciparum (Pf) parasitemia was detected using a HRP-II antigen based rapid
test (Paracheck-Pf®). Pf prevalence was estimated from screenings conducted in 49 villages
participating in a malaria control program, and four retrospective mortality cluster surveys
encompassing a sampling frame of more than 220,000. Crude odds ratios were calculated to
evaluate Pf prevalence by age, sex, and dry vs. rainy season.
Results: 9,796 rapid tests were performed among 28,410 villagers in malaria program areas
through four years (2003: 8.4%, 95% CI: 8.3 – 8.6; 2004: 7.1%, 95% CI: 6.9 – 7.3; 2005:10.5%, 95%
CI: 9.3 – 11.8 and 2006: 9.3%, 95% CI: 8.2 – 10.6). Children under 5 (OR = 1.99; 95% CI: 1.93 –
2.06) and those 5 to 14 years (OR = 2.24, 95% CI: 2.18 – 2.29) were more likely to be positive than
adults. Prevalence was slightly higher among females (OR = 1.04, 95% CI: 1.02 – 1.06) and in the
rainy season (OR = 1.48, 95% CI: 1.16 – 1.88). Among 5,538 rapid tests conducted in four cluster
surveys, 10.2% were positive (range 6.3%, 95% CI: 3.9 – 8.8; to 12.4%, 95% CI: 9.4 – 15.4).
Conclusion: Prevalence of plasmodium falciparum in conflict areas of eastern Burma is higher than
rates reported among populations in neighboring Thailand, particularly among children. This
population serves as a large reservoir of infection that contributes to a high disease burden within
Burma and likely constitutes a source of infection for neighboring regions."

"Decades of repressive military rule, civil war, corruption, bad governance, isolation, and
widespread violations of human rights and international humanitarian law have rendered
Burma’s health care system incapable of responding effectively to endemic and emerging
infectious diseases. Burma’s major infectious diseases—malaria, HIV/AIDS, and tuberculosis
(TB)—are severe health problems in many areas of the country. Malaria is the most common
cause of morbidity and mortality due to infectious disease in Burma. Eighty-nine percent of the
estimated population of 52 million lived in malarial risk areas in 1994, with about 80 percent of
reported infections due to Plasmodium falciparum, the most dangerous form of the disease.
Burma has one of the highest TB rates in the world, with nearly 97,000 new cases detected each
year.4 Drug resistance to both TB and malaria is rising, as is the broad availability of counterfeit
antimalarial drugs. In June 2007, a TB clinic operated by Médecins Sans Frontières–France in
the Thai border town of Mae Sot reported it had confirmed two cases of extensively drugresistant
TB in Burmese migrants who had previously received treatment in Burma. Meanwhile,
HIV/AIDS, once contained to high-risk groups in Burma, has spread to the general population,
which is defined as a prevalence of 1 percent among reproductive-age adults.5
Meanwhile, the Burmese government spends less than 3 percent of national expenditures on
health, while the military, with a standing army of over 400,000 troops, consumes 40 percent.6
By comparison, many of Burma’s neighbors spend considerably more on health: Thailand
(6.1%7), China (5.6 %8), India (6.1%9), Laos (3.2%10), Bangladesh (3.4%11), and Cambodia
(12%12).....The report recommends that:
• The Burmese government develop a national health care system in which care is
distributed effectively, equitably, and transparently.
• The Burmese government increase its spending on health and education to confront
the country’s long-standing health problems, especially the rise of drug-resistant
malaria and tuberculosis.
• The Burmese government rescind guidelines issued last year by the country’s
Ministry of National Planning and Economic Development because these guidelines
have restricted such organizations as the International Committee of the Red Cross
(ICRC) from providing relief in Burma.
• The Burmese government allow ICRC to resume visits to prisoners without the
requirement that ICRC doctors be accompanied by members of the Union Solidarity
and Development Association or other organizations.
• The Burmese government take immediate steps to halt the internal conflict and
violations of international human rights and humanitarian law in eastern Burma that
are creating an unprecedented number of internally displaced persons and facilitating
the spread of infectious diseases in the region.
• Foreign aid organizations and donors monitor and evaluate how aid to combat
infectious diseases in Burma is affecting domestic expenditures on health and
education.
• Relevant national and local government agencies, United Nations agencies, NGOs
establish a regional narcotics working group which would assess drug trends in the
region and monitor the impact of poppy eradication programs on farming
communities.
• UN agencies, national and local governments, and international and local NGOs
cooperate closely to facilitate greater information-sharing and collaboration among
agencies and organizations working to lessen the burden of infectious diseases in
Burma and its border regions. These institutions must develop a regional response
to the growing problem of counterfeit antimalarial drugs."

Summary: Chloroquine (CQ) and sulphadoxine/pyrimethamine (SP) are two first-line antimalarials used under the
existing Indian National Drug Policy in the north-eastern region of India bordering several countries
including Myanmar. Although widespread resistance to antimalarials in Plasmodium falciparum has
been reported from western Myanmar, information from the Indian side of the border is scarce. We
studied the therapeutic response to CQ and SP at four sites in Changlang and Lohit, two administrative
districts of Arunachal Pradesh bordering Myanmar. We monitored uncomplicated falciparum malaria
patients after treatment with standard regimens of CQ and SP for 28 days following the revised in-vivo
protocol of the World Health Organization. A total of 236 patients, 95 in the CQ group and 141 in the
SP group, participated. We recorded 23.8% early treatment failures to CQ and 14.1% to SP; late clinical
failures of 14.3 and 12.6%; late parasitological failures of 10.7 and 8.1% and adequate clinical and
parasitological responses of 51.2 and 65.2%, respectively. The significantly different treatment failure
rates seen in Chowkham (furthest from Indo-Myanmar border) and Jairampur/Nampong (nearest to
Indo-Myanmar border) for chloroquine (Cox proportion hazard ratio 9.1, P < 0.0001) and SP (Cox
proportion hazard ratio 7.35, P ¼ 0.001) denote a non-response gradient to the two antimalarials
extending from the international border. The gradient is probably indicative of the direction of
movement of the drug-resistant P. falciparum parasite. The utility of chloroquine as the first-line drug
under the present National Drug Policy in these areas needs reconsideration...
Keywords: antimalarial, drug resistance, in-vivo sensitivity, border area malaria, chloroquine,
sulphadoxine/pyrimethamine, therapeutic failure

"...Malaria is one of the major public health problems in Myanmar and is reported as the leading cause of
morbidity and mortality. A major risk group is non-immune adult migrants in forests who work in gem mining,
logging, agriculture, plantations and construction. In addition to their lack of immunity against clinical malaria,
migrant workers are also vulnerable to poor access to laboratory and treatment services and language barriers. As
a result, about 70% of reported malaria cases in Myanmar are olde than 15 years of age, and about 60% of cases
are related to forestry work. Myanmar experienced 56 malaria outbreaks between 1991 and 2000, with
international migration being the most important factor of those outbreaks. Given poor access to health care in
remote areas where most cases originate, the total malaria burden is likely to be much higher than reported.
Moreover, self-treatment is common, and malaria reporting does not include cases treated in the private sector or
through traditional medicine practices..."

With a Pilot Study on the Right to Health in Constitution.
A thesis submitted in conformity with the requirements for the degree of Master's in Law (LL.M)
Table of Contents:
Chapter I: Introduction...
Chapter II: Malaria As Public Health Problem Globally and in Burma:
2.2 Malaria as a Global Public Health Problem;
2.2.1Basic Description of Malaria as a Disease;
2.3 The Global Disease Burden of Malaria;
2.3.1 Epidemiological Data;
2.3.2 Economic Cost of Malaria;
2.3.3 The Causal Factors Behind Malaria's Global Disease Burden;
2.3.3.1Health System Failure;
2.3.3.2 Drug Resistance;
2.3.3.3 Population Movement;
2.3.3.4 Deteriorating; 2.3.3.5 Poverty;
2.3.3.6 Environmental Degradation
2.4 Malaria as a Public Health Problem in Burma 2.4.1 The Burden of Malaria in Burma;
2.4.2 Causal Factors Behind Burma's Growing Malaria Problem;
2.4.2.1 Political Instability and Oppression;
2.4.2.2 Failure of the Burmese Public Health and Healthcare System;
2.4.2.3 Environmental Degradation Along Burma Frontier...
Chapter III: Law, Public Health and Malaria in Burma:
3.2 Law and Public Health;
3.2.1 Public Health as a Government Responsibility;
3.2.2 Law as Critical to the Public Health Endeavor;
3.3 Gostin's Definition and Theory of Public Health;
3.3.1 Gostin's Definition of Public Health Law
3.3.2 Gostin's Theory of Public Health Law;
3.3.2.1 The Government;
3.2.2 Populations;
3.3.2.3 Relationships;
3.3.2.4 Services;
3.3.2.5 Coercion;
3.4 Law, Public Health, and Malaria Control in Burma;
3.4.1Burma and the Rule of Law;
3.4.2 Burmese Definition of Public Health Law;
3.4.2.1 Government;
3.4.2.2 Populations;
3.4.2.3 Relationships;
3.4.2.4 Services;
3.4.2.5 Coercion;
3.5 Lessons Learned from Applying Gostin's Theory of Public Health Law to
Malaria Control in Burma...
Chapter IV: Current Malaria Governance Initiatives: From the Global to the Local:
4.1 Introduction;
4.2 Initiatives on Global Health Governance for Malaria;
4.2.1 What is ï¿½Global Health Governance'?
4.2.2 Global Malaria Initiatives;
4.2.2.1 WHO's Roll Back Malaria;
4.2.2.2 Public-Private Partnerships (PPPs) on Malaria Drug and Vaccine Developmen;t
4.2.2.3 The Global Fund to Fight AIDS, Tuberculosis, and Malaria;
4.3 Global Malaria Initiatives and National Malaria Governance in Burma;
4.3.1 Burma and the Roll Back Malaria Campaign;
4.3.2 Burma and the Public-Private Partnerships (PPPs) on Malaria Drug and Vaccine Development;
4.3.3 Burma and the Global Fund to Fight AIDS, Tuberculosis, and Malaria;
4.4 Conclusion...
Chapter V: The Need for The Right to Health: Burma New Constitution:
5.1 Introduction;
5.2 The Right to Health in International Law;
5.3 The Right to Health in Constitutional Law;
5.3.1 Why the Right to Health in Constitutional Law?
5.3.2 The Right to Health in the South African Constitution;
5.3.2.1 Soobramoney v. Minister of Health, KwaZulu-Natal;
5.3.2.2 Treatment Action Campaign (TAC), et al (Applicants) v. Minister of Health, et al (Respondents);
5.4 Building the Right to Health into the New Burmese Constitution;
5.4.1 Why Analyze the Draft Constitution?;
5.4.2 Analysis of the Lack of Specific Public Health Provisions in the Draft Constitution;
5.4.3 A Potential Right to Health Provision for the New Burmese Constitution;
5.5 Conclusion;
Chapter VI: Conclusion...BIBLIOGRAPHY...
APPENDICIES:
A. Soobramoney v Minister of Health (Kwazulu-Natal) in Constitutional Court of South Africa, CCT32/97 (27 November 1997) http://www.concourt.gov.za/date1997.html;
B. Minister of Health v Treatment Action Campaign in Constitutional Court of South Africa, CCT8/02 (5 July 2002) http://www.concourt.gov.za/date2002.html;
C. The Constitution of the Republic of South Africa: Chapter II, Bill of Rights;
D. The Draft Constitution of the (Future) Federal Union of Burma Drafted by National Council of the Union of Burma: Chapter II, Basis Rights;
E. The International Covenant on Economic, Social and Cultural Rights (ICESCR)...
CV.

Abstract. In vitro drug susceptibility profiles were assessed in 75 Plasmodium falciparum isolates from 4 sites in
Myanmar. Except at Mawlamyine, the site closest to the Thai border, prevalence and degree of resistance to mefloquine
were lower among the Myanmar isolates as compared with those from Thailand. Geometric mean concentration that
inhibits 50% (IC50) and 90% (IC90) of Mawlamyine isolates were 51 nM (95% confidence interval [CI], 40–65) and
124 nM (95% CI, 104–149), respectively. At the nearest Thai site, Maesod, known for high-level multidrug resistance,
the corresponding values for mefloquine IC50 and IC90 were 92 nM (95% CI, 71–121) and 172 nM (95% CI, 140–
211). Mefloquine susceptibility of P. falciparum in Myanmar, except for Mawlamyine, was consistent with clinicalparasitological
efficacy in semi-immune people. High sensitivity to artemisinin compounds was observed in this
geographical region. The data suggest that highly mefloquine-resistant P. falciparum is concentrated in a part of the
Thai-Myanmar border region.

Three studies were carried out to determine the need, acceptability, and efficacy of adding mefloquine to
artemisinin derivatives (AD) for the first-line treatment of uncomplicated falciparum malaria. The first was a
retrospective study of 255 basic health workers which showed that their recommendation ofAD to patients
depended on their level of training. None of the paramedics/midwives and only 9% of 129 doctors had
prescribed AD, and no one had recommended AD in combination with mefloquine; 72% of patients used
courses that were too short for parasitological cure. To promote the addition of mefloquine to AD regimens
we conducted intervention workshops with health care providers and subsidized the cost of mefloquine to
patients. In the second study, we interviewed 200 patients before and after the intervention to evaluate drug
compliance with fulidoses ofAD and use of subsidized mefloquine. After the intervention, we found that only
3.6% had used mefloquine and 62% had taken non-curative doses of AD. In the third study, we provided
blister packs of medication in daily doses and compared the intake ofAD + placebo (158 patients) with that
ofAD + mefloquine (222 patients) for 5 days. The compliance with both regimens was 99%. Blood smears
for parasites on day 28 showed one positive in the AD + mefloquine group and 7 positive in the AD group.
We conclude that provision of blister packs of daily doses is a very effective way to improve compliance with
short courses and drug combinations, but the efficacy of the combination in Myanmar in this particular study
was only marginally higher than that of AD alone.

RANGOON, Feb 25, 2010 (IPS) - When Aye Aye (not her real name) leaves her youngest son at home each night, she tells him that she has to work selling snacks. But what Aye actually sells is sex so that her 12-year-old son, a Grade 7 student, can finish his education.

The oppressive regime running Burma has both forced many Burmese into displaced person camps in Thailand. Young Burmese people are particularly vulnerable, especially due to issues such as sexual health education and trafficking.
By any account, Burma is a beautiful, naturally rich country with a diverse ethnic history. It is also run by one of the most oppressive regimes in the world, the State Peace and Development Council, an 11-member group of military commanders. This junta, in power under different names since 1988, has been cited for countless human rights abuses. The SPDC also oversees a corrupt, inefficient economy. In spite of the country’s natural wealth, social-economic conditions continue to deteriorate, along with Burma’s schools and hospitals.

"The World Health Organization (WHO) estimates
that 9,000 multidrug-resistant tuberculosis (MDR-TB)
cases occur in Myanmar each year. Extensively
drug-resistant TB (XDR-TB) has been reported since
2007.
In 2011, only 2% of MDR-TB cases received adequate
diagnosis, treatment and care. Undiagnosed or
mismanaged MDR-TB cases lead to further spread of
the disease.
he Ministry of Health is committed to ighting
MDR-TB. In 2009 the National TB Programme (NTP)
and Médecins Sans Frontières (MSF) launched an
MDR-TB pilot project in 10 townships in Yangon and
Mandalay.
Following excellent initial results, the NTP is taking
MDR-TB management to scale. The 2011-2015
MDR-TB expansion plan will enable treatment of
nearly 10,000 MDR-TB cases in 100 townships. he total cost of scaling up MDR-TB managemen is US$ 55 million, out of which US$ 41 million is yet to be raised. While the top priority
remains preventing MDR-TB by sustaining and improving basic TB control, the Ministry of Health is working with technical and inancial
partners towards the goal of universal access to MDR-TB diagnosis, treatment and care..."

YANGON, March 25 — Myanmar is seeking new drugs, diagnosis and vaccine to fight tuberculosis (TB), the deadly disease that is on the rise again.
The measures also covers promoting the anti-TB campaign with the cooperation of partners, fighting TB through primary healthcare and disseminating public health knowledge, official daily the New Light of Myanmar said Thursday.
The paper quoted an annual report of the health ministry as saying that Myanmar was able to find and cure over 130,000 TB patients in 2009, meeting the millennium goal of the United Nations as discovery rate reached 94 percent and treatment success rate hit 85 percent.

JAPAN International Cooperation is leading the fight against three major diseases in Myanmar. The Myanmar Times’ Khin Myat met with JICA project leader and tuberculosis specialist, Mr Kosuke Okada, and malaria expert Mr Masatoshi Nakamura to ask about their activities.
1. How much money is JICA spending annually to control these diseases?
Our project period is from January 2005 to January 2010. We have been spending around ¥150 million per year on long- and short-term experts, international and domestic training, provision of equipment such as vehicles, lab equipment, microscopes, mosquito nets, lab test kits, local training and consumables.

Abstract:
"Decades of neglect and abuses by the Burmese government have decimated the health of the
peoples of Burma, particularly along her eastern frontiers, overwhelmingly populated by
ethnic minorities such as the Shan. Vast areas of traditional Shan homelands have been
systematically depopulated by the Burmese military regime as part of its counter-insurgency
policy, which also employs widespread abuses of civilians by Burmese soldiers, including
rape, torture, and extrajudicial executions. These abuses, coupled with Burmese government
economic mismanagement which has further entrenched already pervasive poverty in rural
Burma, have spawned a humanitarian catastrophe, forcing hundreds of thousands of ethnic
Shan villagers to flee their homes for Thailand. In Thailand, they are denied refugee status
and its legal protections, living at constant risk for arrest and deportation. Classified as
“economic migrants,” many are forced to work in exploitative conditions, including in the
Thai sex industry, and Shan migrants often lack access to basic health services in Thailand.
Available health data on Shan migrants in Thailand already indicates that this population
bears a disproportionately high burden of infectious diseases, particularly HIV, tuberculosis,
lymphatic filariasis, and some vaccine-preventable illnesses, undermining progress made by
Thailand’s public health system in controlling such entities. The ongoing failure to address
the root political causes of migration and poor health in eastern Burma, coupled with the
many barriers to accessing health programs in Thailand by undocumented migrants,
particularly the Shan, virtually guarantees Thailand’s inability to sustainably control many
infectious disease entities, especially along her borders with Burma."

"Decades of repressive military rule, civil war, corruption, bad governance, isolation, and
widespread violations of human rights and international humanitarian law have rendered
Burma’s health care system incapable of responding effectively to endemic and emerging
infectious diseases. Burma’s major infectious diseases—malaria, HIV/AIDS, and tuberculosis
(TB)—are severe health problems in many areas of the country. Malaria is the most common
cause of morbidity and mortality due to infectious disease in Burma. Eighty-nine percent of the
estimated population of 52 million lived in malarial risk areas in 1994, with about 80 percent of
reported infections due to Plasmodium falciparum, the most dangerous form of the disease.
Burma has one of the highest TB rates in the world, with nearly 97,000 new cases detected each
year.4 Drug resistance to both TB and malaria is rising, as is the broad availability of counterfeit
antimalarial drugs. In June 2007, a TB clinic operated by Médecins Sans Frontières–France in
the Thai border town of Mae Sot reported it had confirmed two cases of extensively drugresistant
TB in Burmese migrants who had previously received treatment in Burma. Meanwhile,
HIV/AIDS, once contained to high-risk groups in Burma, has spread to the general population,
which is defined as a prevalence of 1 percent among reproductive-age adults.5
Meanwhile, the Burmese government spends less than 3 percent of national expenditures on
health, while the military, with a standing army of over 400,000 troops, consumes 40 percent.6
By comparison, many of Burma’s neighbors spend considerably more on health: Thailand
(6.1%7), China (5.6 %8), India (6.1%9), Laos (3.2%10), Bangladesh (3.4%11), and Cambodia
(12%12).....The report recommends that:
• The Burmese government develop a national health care system in which care is
distributed effectively, equitably, and transparently.
• The Burmese government increase its spending on health and education to confront
the country’s long-standing health problems, especially the rise of drug-resistant
malaria and tuberculosis.
• The Burmese government rescind guidelines issued last year by the country’s
Ministry of National Planning and Economic Development because these guidelines
have restricted such organizations as the International Committee of the Red Cross
(ICRC) from providing relief in Burma.
• The Burmese government allow ICRC to resume visits to prisoners without the
requirement that ICRC doctors be accompanied by members of the Union Solidarity
and Development Association or other organizations.
• The Burmese government take immediate steps to halt the internal conflict and
violations of international human rights and humanitarian law in eastern Burma that
are creating an unprecedented number of internally displaced persons and facilitating
the spread of infectious diseases in the region.
• Foreign aid organizations and donors monitor and evaluate how aid to combat
infectious diseases in Burma is affecting domestic expenditures on health and
education.
• Relevant national and local government agencies, United Nations agencies, NGOs
establish a regional narcotics working group which would assess drug trends in the
region and monitor the impact of poppy eradication programs on farming
communities.
• UN agencies, national and local governments, and international and local NGOs
cooperate closely to facilitate greater information-sharing and collaboration among
agencies and organizations working to lessen the burden of infectious diseases in
Burma and its border regions. These institutions must develop a regional response
to the growing problem of counterfeit antimalarial drugs."

This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the franchise were identified. They were interviewed about social conditions, health seeking and health care costs at the time of starting treatment and again after 6 months follow-up. Routine data were used to ascertain clinical outcomes as well as to monitor trends in case notification.

Author/creator:

# Knut Lönnroth, Tin Aung, Win Maung, Hans Kluge and Mukund Uplekar

Language:

English

Source/publisher:

The London School of Hygiene and Tropical Medicine via Health Policy and Planning

Abstract: "A cross-sectional descriptive study was carried out at a tuberculosis center, Yangon,
Myanmar from October 2003 to July 2004 to analyze the drug susceptibility of new sputum
smear positive pulmonary tuberculosis patients. A total of 202 Mycobacterium tuberculosis
isolates were tested for resistance to isoniazid, streptomycin, rifampicin and ethambutol. Resistance
to at least one anti-tuberculosis drug was documented in 32 (15.8%) isolates. Monoresistance
(resistance to one drug) was noted in 15 (7.4%) isolates and poly-resistance (resistance
to two or more drugs) was noted in 17 (9.4%) isolates, including 8 (4.0%) multi-drug
resistant isolates (resistance to at least isoniazid and rifampicin). Total resistance to individual
anti-tuberculosis drugs were: isoniazid (29, 14.3%), streptomycin (11, 5.4%), rifampicin (10,
4.9%) and ethambutol (1, 0.5%). The demographic data and possible contributing factors of
drug resistance were evaluated among the drug resistant patients. Poly-resistant cases had
significantly longer intervals between symptom appearance and achieving effective anti-tuberculosis
treatment than mono-resistant cases (p = 0.015)."

Summary:
Myanmar as a Party to the WHO Framework Convention on Tobacco Control had
adopted the Control of Smoking and Consumption of Tobacco Products Law in 2006
which came into effect in May, 2007. Ministry of Health has been implementing
tobacco control activities in collaboration with related ministries; school-based
tobacco control activities are being conducted in coordination with the Ministry of
Education. Myanmar conducted Global Youth Tobacco Surveys (GYTS) in 2001,
2004 and 2007 and the Global School Personnel Surveys (GSPS) in 2004 and 2007.
The GYTS is a school-based survey of students aged 13-15 years. The GSPS is also a
school-based survey of all school personnel from the schools that the GYTS was
conducted. The GYTS and GSPS were conducted as a nation-wide survey in
Myanmar.
Between 2001 and 2007, a significant reduction in the proportion of students currently
smoked cigarettes is observed (a fall from overall prevalence among 13-15 year olds
of 10.2% to 4.9%) but reported use of other tobacco products had increased during the
period from 5.7% to 14.1%. Over the period, exposure to SHS at home and in public
places did not change and stayed significantly high. There is very high demand from
these children to ban smoking in public places (almost 90% of the children expressed
this desire in both years). The ability to purchase cigarettes in a store had reduced
significantly from 72.9% to 23.7%; percent who have been offered “free “cigarettes
by a tobacco company had also reduced significantly from 17.1% to 8.7%. There is no
change in percent of students receiving education on dangers of tobacco.
There was relatively high prevalence of tobacco use among male school personnel
( 17% daily chewers, 22% occasional chewers ) ( 7.4% daily cigarette smokers, 29%
occasional cigarette smoker)( 15% daily cheroot smokers and 18.4% occasional
cheroot smokers). Schools had policy prohibiting tobacco use among students as well
as students inside school buildings and on school premises, but enforcement was
weak, especially for school personnel. Only one third of the school personnel had
received training on prevention of tobacco use among youth.

Introduction:
Overview of Communicable Diseases;
Emerging and Re-emerging Infectious Diseases;
Principles of Prevention and Control of Communicable Diseases...
Disease Control Tools:
Basic Concepts of Health Measurement/Disease Frequency in Epidemiology...
Different Approaches:
4Role in Prevention, One Example of Immunization: Measles;
Outline of Surveillance and Response Plans: Bird flu in Thailand;
How to Break the Chain of Transmission: Tuberculosis;
Steps in Outbreak Management: Meningitis;
Dealing with Drug Resistance: Malaria;
Fighting Against Vectors: An Example of Mosquito Control...
From the Field:
100 HIV/AIDS Control: A Comprehensive Approach;
Highly Active Anti Retro Viral Therapy (HAART): Adherence and Influencing
Factors;
Community Education on Birdflu: A Method of Participatory Learning and Action.

GENERAL HEALTH:
Structures and functions of respiratory tract;
Bird flu at a glance�
DIAGNOSIS:
Clinical approach to children with cough and/or difficulty breathing
Clinical features of acute upper respiratory tract infections;
Acute community acquired pneumonia in previously healthy lungs�
MANAGEMENT:
Treatment of acute community acquired pneumonia in
previously healthy lungs;
How to deal with an acute asthma patient?
Coping with common cold and flu�
FROM THE FIELD:
Pneumonia case study;
Recurrent respiratory infections in children�
PREVENTION:
Prophylaxis of Pneumocystic carinii pneumonia in HIV-AIDS;
Glossary... Obese file in course of treatment

New Government Restrictions Make Grant Implementation Impossible
Geneva - Given new restrictions recently imposed by the government of Myanmar, the Global Fund has concluded that its grants to the country cannot be managed in a way that ensures effective program implementation. As a result the Global Fund yesterday terminated its grant agreements to Myanmar.
The decision means that three grants, one each for HIV/AIDS, tuberculosis and malaria, with a total value of US$ 35.7 million over two years, will be phased out by the end of the year. The decision has been taken after consultations with the United Nations Development Programme (UNDP), which is the Principal Recipient of Global Fund grants in Myanmar. The Principal Recipient is responsible for grant implementation in the country.

OBJECTIVES: This report aims to describe the prevalence of cigarette and other tobacco use as well as
information on five determinants of tobacco use of 8th, 9th and 10th students in Myanmar: access/
availability and price, environmental tobacco smoke exposure (ETS), cessation, media and
advertising, and school curriculum. These determinants are components of the comprehensive
tobacco control programme of Myanmar. The report also describes the knowledge, attitudes and
behaviour regarding to tobacco use, the extent to which they receive anti-tobacco information in
schools and from media and the extent they were exposed to pro-tobacco messages.....
METHODS: A multi-stage, school-based, two –cluster survey ( n= 6,100, 8th, 9th and 10th graders)
was conducted in 100 basic education middle and high schools of Myanmar, using a pre-tested,
modified questionnaire based on the Global Youth Tobacco Survey questionnaire developed by
Office on Smoking and Health of Center for Communicable Disease Control, Atlanta.....
INTRODUCTION:
Tobacco use is the biggest public health tragedy since it is estimated to kill approximately half of its
long-term users, and of these, half will die during productive middle age, losing 20 to 25 years of
life. Peto and Lopez estimated that about 100 million people were killed by tobacco in the 20th
century and that for the 21st century; the cumulative number could be 1 billion of current smokers.1
The increased use of tobacco is one of the greatest public health threats for the 21st century and the
tobacco epidemic is being spread and reinforced through complex mix of factors that transcend
national borders. For the international public health community tobacco is clearly a global threat.
Globalization of the tobacco epide mic restricts the capacity of countries to regulate tobacco through
domestic legislation alone. In response to the globalization of the tobacco epidemic, the 191 member
States of World Health Organization unanimously adopted the WHO Framework Convention on
Tobacco Control at the 56th World Health Assembly in May 2003, as a global complement to
national actions.
Myanmar, along with other Member Countries of the WHO South-East Asia Region is one of the
Parties to the Convention. Surveillance of tobacco use is one of the components of the WHOFCTC;
more than a surveillance tool on prevalence of tobacco use, the GYTS covers many important
determinants of tobacco use which has been addressed in the FCTC such as advertising, cessation,
education at schools, promoting of community awareness through anti-tobacco campaigns, access of
tobacco products by minors and exposure to environmental tobacco smoke (ETS).

"Each year since 1999 the NTP of Myanmar has detected more TB cases, with improving treatment success rates since 2003. High
notification rates, coupled with preliminary results of a disease prevalence survey in Yangon, suggest that the burden of TB is probably
higher than currently estimated. Slightly less than half of the 2006 TB control budget was funded, and funding gaps for 2007 and 2008
are larger still. The absence of a secure supply of first-line drugs poses a serious threat to the work of the NTP, the possible consequences
of which include increasing drug resistance and loss of public confidence in TB control services."

"Despite limited resources, the NTP continues to improve the quality of and access to TB services, and is close to reaching the global target
for treatment success. Although Myanmar maintains a high rate of case detection, analysis from a recent TB prevalence survey in Yangon is
likely to show an underestimate of the TB burden. The arrival of the new Three Diseases Fund will allow the NTP to continue basic programme
needs while scaling up collaborative TB/HIV activities and initiatives to engage all care providers and involve the community..."

In September 2000, an outbreak of typhoid fever was reported in a rural village of Central Myanmar.
The authors investigated the outbreak in the affected village. A suspected case was a person suffering from
fever with either constipation, abdominal pain, diarrhoea / bloody diarrhoea. A probable case was a suspected
case who had positive result on the diazo urine test or widal test. Based on probable cases, the authors
conducted a case-control study comparing history of contact with the cases, water source, and personal
hygiene. Control was a person living in the village was not ill and having a negative result for diazo urine
test. Among 49 suspected cases, 33 were probable. Attack rate was 1.2%. Three cases had a positive culture
for Salmonella typhi and were not drug resistant. The following risk factors were identified: drinking
unboiled river water (adjusted OR 12.5, 95%CI 2.8-75.3), history of contact with other patients before the
illness (adjusted OR 22, 95%CI 3.5-76.2), no hand washing with soap after defecation (adjusted OR 0.15,
95% CI 0.03 - 0.81). Environmental investigation result showed that most of the households had unsanitary
latrine and some latrines were constructed near the edge of a river. The outbreak subsided quickly after
intervention.
Keywords : Typhoid fever, Outbreak, Myanmar

WHEN the biopsy result came back, tears were rolling down 63-year-old Daw Khin Tin’s face.
“While I was bathing, just by chance I touched a small lump in my breast. It wasn’t painful but one week later it seemed bigger so I went to a clinic and the doctor urged me to have a biopsy done straight away,” Daw Khin Tin said.
“The results showed the cancer was already at stage three,” the final stage before it spreads to other parts of the body. “I was haunted by the disease and lived with the constant fear that I would die.”

Abstract:
"The objective of this study was to determine the prevalence of hypertension among the 15-years-or-above population in Ta-Yoke-Hla (TYH) and Myaning-Ga-Lay (MGL) villages in Kayin state. During the cross-sectional survey conducted in November 2001, 753 respondents (370 in TYH and 383 in MGL) were interviewed. Weight, height, waist circumference and hip circumference were measured for calculation of body mass index (BMI) and waist-hip ratio. Of them, 108 (54 with hypertension and 54 with normal blood pressure) were examined for serum cholesterol and high density lipoprotein (HDL) level. The overall percentages of hypertension (systolic ³140 mmHg and diastolic ³ 90 mmHg) were: 22.4% for both townships; 17.3% in TYH; 27.4% in MGL; 18.7% among males, and 24.5% among females. The respective percentages of hypertension among different age groups (15-24 years, 25-39 years, 40 or above) were: 5.5%; 12.7%, and 38.1% for both townships; 3.8%; 11.3%, and 31.3% in TYH; 7.6%; 14.0%, and 43.7% in MGL; 3.9%; 13.2%, and 30.7% among males, and 6.5%; 12.4%, and 42.4% among females. Sixteen (2.1%) persons reported previous history of stroke. Biochemical levels and other known factors associated with hypertension are also described in the study. Health education should include among others, education on taking treatment for hypertension regularly."

"Non communicable diseases (NCDs) are the leading global cause of death and disability. Between and within countries, however, there is still a marked diversity in the causes and nature of this disease transition. In Myanmar, economic and political reforms, and the ways in which these intersect with health, have created a unique public health and development context with major ramifications for public health. Myanmar’s transition creates anl opportunity to learn from the public health and development mistakes made elsewhere, but signs are at present that the rush towards short term economic opportunities is taking precedence. This piece illustrates some of the local dynamics that drive NCDs in Myanmar, and potential entry points for the international community to help address Myanmar’s next major health challenge..."

Myanmar is one of the few countries in East Asia that has reported a decrease in the overall
prevalence of HIV in recent years. Estimates indicate that HIV prevalence peaked at about 0.9%
(15-49%). By 2007, the estimated prevalence was 0.7% (range: 0.4-1.1%).....
Myanmar remains the second largest opium
poppy growing country after Afghanistan,
contributing 20% of opium poppy cultivation
in major cultivating countries in 2008.3 Heroin
use has become widespread and is the
primary drug of choice among people who
inject drugs. While the use of heroin and
opium has been observed to be declining in
recent years, the use of methamphetamine
has been increasing since 2003. Injecting of
amphetamine type stimulants has also been
reported to occur, as well as injecting of a
mixture of opiates and pharmaceutical
drugs.

"Substance abuse refers to the harmful or
hazardous use of psychoactive substances, including
alcohol and illicit drugs. It can also be
simply defined as a pattern of harmful use of
any substance for mood-altering purposes.
Generally, when most people talk about
substance abuse, they are referring to the use
of illegal drugs. But illegal drugs are not the
only substances that can be abused. Alcohol,
prescribed medications, inhalants and even
coffee and cigarettes, can be used to harmful
excess.
Substance abuse can lead to dependence
syndrome - a cluster of behavioural, cognitive,
and physiological phenomena that develop
after repeated use including a strong desire
to take the drug, persisting in its use despite
harmful consequences, increased tolerance,
and a physical withdrawal state.
In this guidebook, based upon the situation
in our community, we present the most
common substances that are often abused,
how they are used, their street names, and
their intoxicating and health effects.".....CONTENTS:- Part I:
Alcohol...
Amphetamine, Yaba, Ecstasy...
Benzodiazepines...
Betel Nut and Betal Leaf (Kwan-ya)...
Cannabis...
Cocaine - (Crack)...
Codeine...
Heroin...
Volatile Substance or Inhalants ...
Methadone...
Opium...
Tobacco.....
PART II:-
General Views of Substance Abuse...
Chronic Effects of Alcoholism...
Management in Substance Abuse Overdose...
Psycho-Counselling for Substance Abuse.

Chapter Overview: Farmers are turning to illegal drug cultivation as a way to escape extreme poverty thrust upon them by the relentless civil war. As the situation in Karenni State worsens, more and more farmers will turn to poppy cultivation and the more secure future it promises. Whilst the income that farmers can earn from drugs is significantly higher than from other crops, they remain vulnerable to economic hardships, exploitation and abuses from the Burmese military regime and non-state actors. Furthermore, the increased drug production has led to increased drug abuse amongst the Karenni people, in two districts 35 per cent of males are using opium. This adds pressure to an already inadequate health system while eroding the fragile social fabric of the Karenni people.
In this chapter:
* Types of drugs produced in Karenni State
* Why villagers are producing drugs
* Eradication Programmes
* Social Problems

"'Poisoned Flowers: The Impacts of Spiraling Drug Addiction on Palaung
Women in Burma', based on interviews with eighty-eight wives and mothers of drug
addicts, shows how women in Palaung areas have become increasingly vulnerable due
to the rising addiction rates. Already living in dire poverty, with little access to
education or health care, wives of addicts must struggle single-handedly to support as
many as ten children.
Addicted husbands not only stop providing for their families, but also sell off property
and possessions, commit theft, and subject their wives and children to repeated verbal
and physical abuse. The report details cases of women losing eight out of eleven
children to disease and of daughters being trafficked by their addicted father.
The increased addiction rates have resulted from the regime allowing drug lords to
expand production into Palaung areas in recent years, in exchange for policing against
resistance activity and sharing drug profits. The collapse of markets for tea and other
crops has driven more and more farmers to turn to opium growing or to work as
labourers in opium fields, where wages are frequently paid in opium.
The report throws into question claims by the regime and the UNODC of a dramatic
reduction of opium production in Burma during the past decade, and calls on donor
countries and UN agencies supporting drug eradication programs in Burma to push
for genuine political reform..."

"FIRST it was the melamine scandal, in which a harmful chemical was found in milk and dairy products sold in Burmese stores. Then came the pickled tea scandal, also involving chemical additives—followed by a similar scare over tainted shrimp paste. Burmese consumers are having an increasingly difficult time finding risk-free foodstuffs in the markets these days..."

FAO/WHO Global Forum of Food Safety Regulators
Marrakech, Morocco, 28 - 30 January 2002
"Being a developing agricultural country at least in a foreseeable future, Myanmar is inevitable the use of pesticides in agriculture food production although other parallel efforts of non-chemical nature are being endeavoured in pest control strategies. Although there is a low pesticide consumption rate in Mayanmar, the present data indicates the urgent need of a cautious control in the use through coordination and cooperation of various government agencies and the people themselves. In addition, agricultural pesticides use in the country is expected to be increased with the abrupt change of cropping pattern for high rice production and extension of various crops grown areas.
The use of agro-chemical on food crops is estimated about 80% of the total. At that time the use of organo-chlorine insecticides (oc's) is decreasing but the percentage of those pesticides is total (about 10%) is still high. The use of pyrethroids is increasing..."

This Handbook is designed for both farmers and students to use in the field and during training. It is divided into eight sections, each one containing several topics and all illustrated with large clear pictures. The Handbook can be read from beginning to end or each topic can be read separately. Space is provided for readers to take notes and to add their own local knowledge...Our people have always been farmers. Farmers of the river lands, of the mountains, and of the forests. Due to civil war in Burma, more and more of us have migrated from our native lands and many now live in refugee camps along the Thai-Burmese border. The Royal Thai Government, its citizens, and non-government organisations have been very generous in their support to us. We have food, shelter, health care and education, and for this we are very thankful. But while we have been living in refugee camps we have slowly been losing our heritage, our wisdom, and our ways. For our children, rice comes from a warehouse, not grown on our own land by our own hands. In 1999, I asked the organisations that were already supporting us if they could help me look for ways to teach our children about agriculture and to help us live more self-sufficiently. The result of this is now called the CAN Project (Community Agriculture and Nutrition). This Handbook is the latest step in its ongoing development over 7 years with refugees and internally displaced people along the Thai-Burma border. There are many good books and resources on sustainable agriculture and we have learnt much from them. However refugees are constrained in their agricultural practices due to limited access to land, water and other resources. This Handbook attempts to present a summary of simple adaptations of ideas found in other books, manuals and resources on sustainable agriculture. This Handbook is not a textbook as such, but a compilation of different subjects for people to pick and choose. We know that it is not complete and I would ask anyone with ideas or suggestions to forward them so we can keep on learning. In the year 2000 I wrote a draft CAN Handbook. Then Jacob Thomson and I wrote the first CAN curriculum in 2001. Since then it has been used in training with nearly 5,000 school children, teachers, villagers, and staff of community-based and non-government organisations. Needless to say, since the first curriculum was drafted, we have had many experiences, learnt many lessons and made many changes.

This Handbook is designed for both farmers and students to use in the field and
during training. It is divided into eight sections, each one containing several
topics and all illustrated with large clear pictures. The Handbook can be read
from beginning to end or each topic can be read separately. Space is provided
for readers to take notes and to add their own local knowledge...Our people have always been farmers. Farmers of the river lands, of the
mountains, and of the forests. Due to civil war in Burma, more and more of
us have migrated from our native lands and many now live in refugee camps
along the Thai-Burmese border.
The Royal Thai Government, its citizens, and non-government organisations
have been very generous in their support to us. We have food, shelter, health
care and education, and for this we are very thankful. But while we have been
living in refugee camps we have slowly been losing our heritage, our wisdom,
and our ways. For our children, rice comes from a warehouse, not grown on
our own land by our own hands.
In 1999, I asked the organisations that were already supporting us if they
could help me look for ways to teach our children about agriculture and to
help us live more self-sufficiently. The result of this is now called the CAN
Project (Community Agriculture and Nutrition). This Handbook is the latest
step in its ongoing development over 7 years with refugees and internally
displaced people along the Thai-Burma border.
There are many good books and resources on sustainable agriculture and
we have learnt much from them. However refugees are constrained in their
agricultural practices due to limited access to land, water and other resources.
This Handbook attempts to present a summary of simple adaptations of ideas
found in other books, manuals and resources on sustainable agriculture.
This Handbook is not a textbook as such, but a compilation of different
subjects for people to pick and choose. We know that it is not complete and
I would ask anyone with ideas or suggestions to forward them so we can
keep on learning. In the year 2000 I wrote a draft CAN Handbook. Then Jacob
Thomson and I wrote the first CAN curriculum in 2001. Since then it has
been used in training with nearly 5,000 school children, teachers, villagers,
and staff of community-based and non-government organisations. Needless
to say, since the first curriculum was drafted, we have had many experiences,
learnt many lessons and made many changes.

General Health:
Underlying causes of malnutrition --
Why health workers should feel concerned by nutritional issues? Misconceptions Concerning Nutrition: Voices of Community Health Educators and TBAs along the Thai-Burmese Border;
Micronutrients: The Hidden Hunger; Iron Deficiency Anaemia; The Vicious Circle of Malnutrition and Infection;
Treatment: IDENTIFYING MALNUTRITION; MANAGEMENT OF ACUTE SEVERE MALNUTRITION;
GROWTH MONITORING: THE BEST PREVENTION;
Fortified Flour for Refugees living in the camp;
Making Blended Flour at Local Level;
The example of MISOLA Flour in Africa.
Health Education: Pregnancy and Nutrition;
Breastfeeding;
WHEN RICE SOUP IS NOT ENOUGH:
First Foods - the Key to Optimal Growth and Development;
BUILDING A BALANCED DIET FOR GOOD HEALTH;
From the Field:
How Sanetun became a malnourished child?

Summary: "Summarizes the objectives, implementation, and results of the highly successful Joint WHO/UNICEF Nutrition Support Programme (JNSP) in Myanmar (previously known as Burma). Initiated in 1983, JNSP aims to reduce infant and young child mortality, to improve child growth, and to reduce malnutrition in mothers. To date, the Programme has been implemented in 17 countries with widely varying results. The Myanmar project was distinguished from other JNSP projects because of its focus on the entire population, rather than on model districts or provinces, and its concentration on activities administered almost exclusively through the Ministry of Health. The Myanmar project was further characterized by a situation analysis, conducted prior to the start of the project, which yielded detailed and precise recommendations on how to improve nutrition. A description of the objectives and operation of the programme shows how the situation analysis allowed selection of a few activities for careful implementation and monitoring. The report also explains how a deliberate focus on education, coupled with nutrition monitoring, made it possible to do a few things very well at as low a cost as possible. Other distinctive features include operation through the existing infrastructure for primary health care services and avoidance of providing food supplements. A section devoted to the results of the project documents a decrease of under-three-year-old mortality, faster growth, a decline in protein-energy malnutrition, and improvements in young child feeding practices and health seeking behaviour of mothers. The report concludes that, despite poverty and a deteriorating economic situation, improvements in child health and nutrition can be achieved in a large population, over a short period of time, and at low per capita cost. A final section discusses the project in relation to the theory and practice of nutrition policies and programmes conducted in other countries. The Myanmar project was judged to be sustainable and suitable for replication, at low cost, in all countries that implement primary health care"

The Online Burma Library contains two versions of this 1996 report -- in html with added URLs of references not available online in 1996 and a Word version, without these additions, which keeps, so far as possible, the format of the hard copy.
"Censorship has long concealed a multitude of grave issues in Burma (Myanmar. After decades of governmental secrecy and isolation, Burma was dramatically thrust into world headlines during the short-lived democracy uprising in the summer of 1988. But, while international concern and pressure has since continued to mount over the country's long-standing political crisis, the health and humanitarÂ­ian consequences of over 40 years of political malaise and ethnic conÂ­flict have largely been neglected. Indeed, in many parts of the country, they remain totally unaddressed.
There are many elements involved in addressing the health criÂ­sis which now besets Burma's peoples. A fundamental aspect, in ARTICLE 19's view, is for the rights to freedom of expression and information, together with the right to democratic participation, to be ensured. In a context of censorship and secrecy, individuals cannot make informed decisions on important matters affecting their health. Without freedom of academic research and the ability to disseminate research findings, there can be no informed public debate. Denial of research and information also makes effective health planning and provision less likely at the national level. Without local participation, founded on freedom of expression and access to information, the health needs of many sections of society are likely to remain unaddressed. Likewise, secrecy and censorship have a negative impact on the work of international humanitarian agencies..."

"There are no doctors or hospitals for eastern Myanmar’s displaced civilians, many of them living in recently active conflict zones, in a region with one of the highest rates of landmine injuries in the world.
To address basic and critical emergency health needs, our partner organization, the Karen Department of Health and Welfare (KDHW), developed a mobile medical system uniquely adapted to the region: A network of tiny clinics now dot eastern Myanmar, with local health workers carrying supplies on their backs, walking for weeks through remote jungles to get medical training and reach patients.
Community Partners International trains and equips these Trauma Management Program health workers. See links at right for peer-reviewed publications on our community-based initiatives to address trauma and other critical health needs in Myanmar.".....Best Practices Guidelines on Surgical Response in Disasters and Humanitarian Emergencies...Surgery in Humanitarian Settings (Prehospital and Disaster Medicine, December 2011)...
Trauma Care in Conflict Zones (Human Resources for Health, March 2009)...
Trauma and Mental Health in eastern Myanmar (Conflict & Health July 2013).

On 4th December 2006, Nang Noom Mae Seng, a 37-year old Shan migrant worker from Burma, was left paralysed after being struck by a 300 kilogram mould at her worksite. Her official compensation claim was rejected by Thailand’s SSO. This was because she could not satisfy conditions for access to the WCF laid down in a 2001 SSO circular, requiring that: (1) Workers must possess a passport or alien registration documents; and (2) Their employers must have paid a dividend into the WCF. These conditions make it generally impossible for Burmese migrants to access the WCF.

"Decades of ethnic conflict have left south eastern Myanmar one of the most landmine-ridden regions in the world. Few landmine victims get the treatment they need inside the country, formerly known as Burma, and so spend days travelling to neighbouring Thailand for medical support.
The Mae Tao Clinic provides healthcare to more than 150,000 displaced people every year, from vaccinations, to eye surgery and emergency operations on gunshot wounds. In the clinic’s prosthetics department, where many of the staff are themselves former landmine victims, more than 250 prosthetic limbs are fitted each year.
Nidhi Dutt travels to the border town of Mae Sot to meet the people making tailored prosthetics from the simplest of tools for whoever needs them, no matter which side of Myanmar’s civil conflict they are on..."